Healthcare Provider Details

I. General information

NPI: 1306942156
Provider Name (Legal Business Name): MUKTI V GODBOLE OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NE PARK DR SUITE C
ISSAQUAH WA
98029-2642
US

IV. Provider business mailing address

4220 132ND ST SE SUITE 101
MILL CREEK WA
98012-8999
US

V. Phone/Fax

Practice location:
  • Phone: 425-686-7405
  • Fax: 425-341-9041
Mailing address:
  • Phone: 425-316-8046
  • Fax: 425-338-9637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00003106
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT00003106
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: