Healthcare Provider Details

I. General information

NPI: 1902808942
Provider Name (Legal Business Name): EASTSIDE CHILDREN'S THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 NW JUNIPER ST SUITE 106
ISSAQUAH WA
98027-2717
US

IV. Provider business mailing address

PO BOX 819
ORTING WA
98360-0819
US

V. Phone/Fax

Practice location:
  • Phone: 425-392-2346
  • Fax: 425-392-0185
Mailing address:
  • Phone: 360-893-6576
  • Fax: 360-893-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT00000808
License Number StateWA

VIII. Authorized Official

Name: VIKTORIA LITTLEMAN
Title or Position: OWNER
Credential: OTR/L
Phone: 425-392-2346