=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114263316
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC POON OT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2012
-----------------------------------------------------
Last Update Date | 05/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22500 NE MARKETPLACE DR SUITE 204
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98053-2033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-836-1034
-----------------------------------------------------
Fax | 425-836-1037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1519 132ND ST SE SUITE A
-----------------------------------------------------
City | EVERETT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98208-7203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-357-9380
-----------------------------------------------------
Fax | 425-357-9382
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT60315434
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------