Healthcare Provider Details

I. General information

NPI: 1164346151
Provider Name (Legal Business Name): ALICIA GLENWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 KENOSIA AVE S
KENT WA
98030-5909
US

IV. Provider business mailing address

11846 SE 204TH ST
KENT WA
98031-1611
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-2737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61665849
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: