=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467166884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHOLE LIFE HEALTHY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2023
-----------------------------------------------------
Last Update Date | 01/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3405 NW MAXINE CIR
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97330-3727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-513-6953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3405 NW MAXINE CIR
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97330-3727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-513-6953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ANN MARIE ALLIANO DUNDAS
-----------------------------------------------------
Credential | MSOTR/L
-----------------------------------------------------
Telephone | 732-513-6953
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------