Healthcare Provider Details

I. General information

NPI: 1710147053
Provider Name (Legal Business Name): LILIAN D HEIMBACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 W ALOHA ST
SEATTLE WA
98119-3743
US

IV. Provider business mailing address

2600 34TH AVE W
SEATTLE WA
98199-3225
US

V. Phone/Fax

Practice location:
  • Phone: 206-301-4446
  • Fax:
Mailing address:
  • Phone: 206-691-5340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00002656
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: