Healthcare Provider Details

I. General information

NPI: 1720008337
Provider Name (Legal Business Name): MARY ANN VARNUM CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 22ND AVENUE NW
SEATTLE WA
98117-2712
US

IV. Provider business mailing address

9001 22ND AVE NW
SEATTLE WA
98117-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-789-5132
  • Fax:
Mailing address:
  • Phone: 206-789-5132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License NumberRE00000284
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: