Healthcare Provider Details

I. General information

NPI: 1922692706
Provider Name (Legal Business Name): MIHAELA AURA PRIBEAGU OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
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

11527 30TH AVE NE
SEATTLE WA
98125-6860
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-2716
  • Fax: 425-672-2770
Mailing address:
  • Phone: 177-367-9048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number61117416
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: