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General NPI Number Information
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NPI Number | 1477079960
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Entity Type | Individual
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Provider Name | MARCO VAZQUEZ
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Gender | Male
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 4400 STONE WAY N
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City | SEATTLE
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State | WA
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Zip | 98103-7485
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Country | US
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Telephone | 206-452-3209
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 N 115TH ST APT 309
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City | SEATTLE
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State | WA
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Zip | 98133-8245
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Country | US
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Telephone | 217-994-7353
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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 | OT60888806
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License Number State | WA
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