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General NPI Number Information
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NPI Number | 1215716568
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Entity Type | Individual
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Provider Name | ARNOLD AGRAVIADOR
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Gender | Male
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 933 111TH AVE NE
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City | BELLEVUE
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State | WA
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Zip | 98004-4486
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Country | US
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Telephone | 425-504-8821
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Fax |
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Provider Business Mailing Address
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Address Line | 2580 118TH AVE SE APT 2-104
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City | BELLEVUE
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State | WA
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Zip | 98005-8161
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Country | US
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Telephone | 310-999-9193
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OC61360597
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License Number State | WA
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