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General NPI Number Information
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NPI Number | 1639204993
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Entity Type | Individual
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Provider Name | ANDREA STATHOULIS OTR
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Gender | Female
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20310 19TH AVE NE
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City | SHORELINE
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State | WA
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Zip | 98155-1261
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Country | US
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Telephone | 206-367-5853
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Fax |
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Provider Business Mailing Address
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Address Line | 22814 75TH AVE W
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City | EDMONDS
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State | WA
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Zip | 98026-8514
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Country | US
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Telephone | 425-775-3190
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT00003886
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License Number State | WA
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