Healthcare Provider Details

I. General information

NPI: 1588991715
Provider Name (Legal Business Name): MISS CHALIA YVONNE BOOKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 NE 110TH STREET
SEATTLE WA
97125
US

IV. Provider business mailing address

4560 SE INTERNATIONAL WAY STE 100
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 971-206-5200
  • Fax: 971-206-5203
Mailing address:
  • Phone: 971-206-5200
  • Fax: 971-206-5203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOC60110705
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: