Healthcare Provider Details

I. General information

NPI: 1689786808
Provider Name (Legal Business Name): MARLENE CHIYEKO OKADA DI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 8TH AVE S SUITE 100
SEATTLE WA
98104-3032
US

IV. Provider business mailing address

PO BOX 24911
SEATTLE WA
98124-0911
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3754
  • Fax:
Mailing address:
  • Phone: 206-788-3683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDI00000028
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: