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General NPI Number Information
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NPI Number | 1265171078
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Entity Type | Organization
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Legal Business Name | FEEDING THERAPY FOR KIDS
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 12026 17TH AVE NE
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City | SEATTLE
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State | WA
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Zip | 98125-5116
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Country | US
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Telephone | 425-686-9438
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Fax |
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Provider Business Mailing Address
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Address Line | 4730 UNIVERSITY WAY NE STE 104
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City | SEATTLE
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State | WA
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Zip | 98105-4424
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TANIS RUSIN
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Credential |
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Telephone | 425-341-3108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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