Healthcare Provider Details

I. General information

NPI: 1699340448
Provider Name (Legal Business Name): ELYSE BOSSE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N 145TH ST
SEATTLE WA
98133-6522
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 206-604-4707
  • Fax: 206-367-9203
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number60836136
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: