Healthcare Provider Details

I. General information

NPI: 1942656418
Provider Name (Legal Business Name): SANDRA G KANGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA LEE GREGG

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 16TH AVE E
SEATTLE WA
98112-5226
US

IV. Provider business mailing address

201 16TH AVE E
SEATTLE WA
98112-5226
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-3000
  • Fax: 206-326-2785
Mailing address:
  • Phone: 206-326-3000
  • Fax: 206-326-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT00001121
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT00001121
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: