Healthcare Provider Details

I. General information

NPI: 1649693904
Provider Name (Legal Business Name): ANDREW PEAKER OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NE 139TH ST STE 325
VANCOUVER WA
98686-2319
US

IV. Provider business mailing address

200 NE MOTHER JOSEPH PL STE 210
VANCOUVER WA
98664-3295
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-6161
  • Fax: 360-449-1146
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberTL60441380
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: