Healthcare Provider Details

I. General information

NPI: 1134938707
Provider Name (Legal Business Name): HEIDI L WESLEY CTRS/R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 S LANE ST
SEATTLE WA
98104-3044
US

IV. Provider business mailing address

9733 2ND AVE NW
SEATTLE WA
98117-2016
US

V. Phone/Fax

Practice location:
  • Phone: 206-462-7100
  • Fax:
Mailing address:
  • Phone: 206-859-1786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License NumberRE61646955
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: