Healthcare Provider Details

I. General information

NPI: 1003696915
Provider Name (Legal Business Name): TAYLOR LYNN GUDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 S 144TH ST
TUKWILA WA
98168-4134
US

IV. Provider business mailing address

31 ETRURIA ST APT C
SEATTLE WA
98109-1685
US

V. Phone/Fax

Practice location:
  • Phone: 206-901-8000
  • Fax:
Mailing address:
  • Phone: 724-205-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOC61409073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: