Healthcare Provider Details

I. General information

NPI: 1861213514
Provider Name (Legal Business Name): EMILY MARY HANSON MARKOVICZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 LILLY RD NE STE 240
OLYMPIA WA
98506-5117
US

IV. Provider business mailing address

3901 CAPITAL MALL DR SW STE D
OLYMPIA WA
98502-8654
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-3850
  • Fax: 360-413-3850
Mailing address:
  • Phone: 360-709-6221
  • Fax: 360-359-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61613556
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: