=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316898885
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVANGELINE DONNELSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2026
-----------------------------------------------------
Last Update Date | 02/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 N ALDER AVE
-----------------------------------------------------
City | GRANITE FALLS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98252-8907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-691-7717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14707 87TH AVE SE UNIT L2
-----------------------------------------------------
City | SNOHOMISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98296-7203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT61672206
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------