Healthcare Provider Details

I. General information

NPI: 1699989210
Provider Name (Legal Business Name): NORTHWEST HAND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 GRIFFIN AVE STE 210
ENUMCLAW WA
98022-2373
US

IV. Provider business mailing address

2820 GRIFFIN AVE STE 210
ENUMCLAW WA
98022-2373
US

V. Phone/Fax

Practice location:
  • Phone: 360-802-6838
  • Fax: 360-802-6839
Mailing address:
  • Phone: 360-802-6838
  • Fax: 360-802-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberOT00002354
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4749320001
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerDMERC

VIII. Authorized Official

Name: SUSAN D LOUIE
Title or Position: MANAGER
Credential: OT
Phone: 360-802-6838