=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396982385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GIANT STEPS CHILDREN'S THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2009
-----------------------------------------------------
Last Update Date | 01/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1705 S 324TH PL
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003-8504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-393-8546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 14TH AVE E #3
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98112-5262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-393-8546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | MRS. CARE ANN GOLDENBERG
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 206-393-8546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OT00003262
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------