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General NPI Number Information
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NPI Number | 1013175744
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Entity Type | Organization
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Legal Business Name | ULTIMATE PERFORMANCE REHABILITATION LLC
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 11/27/2013
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Provider Practice Location Address
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Address Line | 19351 8TH AVE NE SUITE 200
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City | POULSBO
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State | WA
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Zip | 98370-8710
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Country | US
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Telephone | 360-697-3003
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Fax | 360-697-3026
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Provider Business Mailing Address
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Address Line | 19351 8TH AVE NE SUITE 200
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City | POULSBO
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State | WA
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Zip | 98370-8710
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Country | US
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Telephone | 360-697-3003
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Fax | 360-697-3026
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | MRS. MEGAN MARIE MILYARD
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Credential | OTR/L
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Telephone | 360-697-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | OT00002325
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License Number State | WA
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