Healthcare Provider Details

I. General information

NPI: 1508288523
Provider Name (Legal Business Name): ELIZABETH ARCHULETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 PROSCH AVE W # 5
SEATTLE WA
98119-2041
US

IV. Provider business mailing address

2821 PROSCH AVE W # 5
SEATTLE WA
98119-2041
US

V. Phone/Fax

Practice location:
  • Phone: 206-941-9892
  • Fax:
Mailing address:
  • Phone: 206-941-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOC 60394001
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: