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General NPI Number Information
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NPI Number | 1205011970
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Entity Type | Organization
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Legal Business Name | HAND THERAPY SPECIALIST, LLC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 3435 MARTIN WAY E STE C
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City | OLYMPIA
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State | WA
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Zip | 98506-5071
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Country | US
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Telephone | 360-923-5840
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Fax | 360-459-4836
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Provider Business Mailing Address
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Address Line | 417 W MAIN ST STE B
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City | CENTRALIA
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State | WA
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Zip | 98531-4263
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Country | US
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Telephone | 360-807-0630
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANIEL C MENDIOLA
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Credential | OTR/L, C,H.T.
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Telephone | 360-923-5840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | OT00000867
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License Number State | WA
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