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General NPI Number Information
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NPI Number | 1053860635
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Entity Type | Organization
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Legal Business Name | DAFFODIL VALLEY CHILDREN'S THERAPY
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 205 15TH AVE SW SUITE B
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City | PUYALLUP
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State | WA
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Zip | 98371
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Country | US
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Telephone | 253-283-5181
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Fax |
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Provider Business Mailing Address
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Address Line | 1206 13TH ST SW
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City | PUYALLUP
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State | WA
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Zip | 98371-7004
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Country | US
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Telephone | 253-283-5181
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Fax |
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Authorized Official
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Title or Position | OWNER,OTR/L
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Name | ERIN JACKOWSKI
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Credential | OTR/L
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Telephone | 253-283-5181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT00004441
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License Number State | WA
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