Healthcare Provider Details

I. General information

NPI: 1669701702
Provider Name (Legal Business Name): SHAHNOOR SHIRAZ DHARAMSI MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11335 NE 122ND WAY, SUITE 105 #146
KIRKLAND WA
98034
US

IV. Provider business mailing address

11335 NE 122ND WAY #146
KIRKLAND WA
98034-6933
US

V. Phone/Fax

Practice location:
  • Phone: 404-429-3296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60227755
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOT60227755
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT60227755
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: