Healthcare Provider Details

I. General information

NPI: 1275107526
Provider Name (Legal Business Name): ELIZABETH WHITAKER MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20818 44TH AVE W STE 270
LYNNWOOD WA
98036-7709
US

IV. Provider business mailing address

19014 96TH AVE NW
STANWOOD WA
98292-7853
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-2716
  • Fax:
Mailing address:
  • Phone: 503-866-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61159832
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: