Healthcare Provider Details

I. General information

NPI: 1265171078
Provider Name (Legal Business Name): FEEDING THERAPY FOR KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12026 17TH AVE NE
SEATTLE WA
98125-5116
US

IV. Provider business mailing address

4730 UNIVERSITY WAY NE STE 104
SEATTLE WA
98105-4424
US

V. Phone/Fax

Practice location:
  • Phone: 425-686-9438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: TANIS RUSIN
Title or Position: OWNER
Credential:
Phone: 425-341-3108