Healthcare Provider Details

I. General information

NPI: 1558763417
Provider Name (Legal Business Name): CARLA PASAGUI INES SYRON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA PASAGUI INES

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W YACOLT RD
YACOLT WA
98675-5426
US

IV. Provider business mailing address

406 W YACOLT RD
YACOLT WA
98675-5426
US

V. Phone/Fax

Practice location:
  • Phone: 360-885-3508
  • Fax:
Mailing address:
  • Phone: 360-885-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60304421
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: