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General NPI Number Information
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NPI Number | 1316369374
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Entity Type | Individual
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Provider Name | CARL ETIENNE OTR
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Gender | Male
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 6004 WESTGATE BLVD STE 220
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City | TACOMA
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State | WA
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Zip | 98406-2503
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Country | US
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Telephone | 253-759-4065
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Fax |
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Provider Business Mailing Address
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Address Line | 440 ELMCROFT BLVD APT 3214
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City | ROCKVILLE
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State | MD
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Zip | 20850-5642
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Country | US
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Telephone | 914-319-8014
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 06200
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License Number State | MD
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