Healthcare Provider Details

I. General information

NPI: 1356704191
Provider Name (Legal Business Name): MEILANI ATACADOR MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 N ARGONNE RD
SPOKANE VALLEY WA
99212-2245
US

IV. Provider business mailing address

PO BOX 11739
SPOKANE VALLEY WA
99211-1739
US

V. Phone/Fax

Practice location:
  • Phone: 509-927-1138
  • Fax:
Mailing address:
  • Phone: 509-927-1138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number60633118
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: