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General NPI Number Information
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NPI Number | 1245562172
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Entity Type | Individual
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Provider Name | SUSAN BROADHURST OT
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Gender | Female
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 4515 MARTIN LUTHER KING JR WAY S SUITE 100
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City | SEATTLE
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State | WA
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Zip | 98108-2182
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Country | US
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Telephone | 206-325-5325
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Fax | 206-325-5326
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Provider Business Mailing Address
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Address Line | 4515 MARTIN LUTHER KING JR WAY S SUITE 100
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City | SEATTLE
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State | WA
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Zip | 98108-2182
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Country | US
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Telephone | 206-325-5325
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Fax | 206-325-5326
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT0001772
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 984994
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License Number State | OR
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