Healthcare Provider Details

I. General information

NPI: 1568718310
Provider Name (Legal Business Name): TREVOR W. PETRIE OTR/L, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 120TH AVE NE STE H220
KIRKLAND WA
98034
US

IV. Provider business mailing address

12911 120TH AVE NE STE H220
KIRKLAND WA
98034-3064
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-4224
  • Fax: 425-820-8975
Mailing address:
  • Phone: 425-823-4224
  • Fax: 425-820-8975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60281894
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT60281894
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: