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General NPI Number Information
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NPI Number | 1649800608
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Entity Type | Organization
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Legal Business Name | PNW HOME FOR LIFE PLLC
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Dates
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Enumeration Date | 01/18/2020
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Last Update Date | 01/18/2020
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Provider Practice Location Address
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Address Line | 4815 SHARPE RD
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City | ANACORTES
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State | WA
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Zip | 98221-8403
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Country | US
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Telephone | 360-770-1752
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Fax |
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Provider Business Mailing Address
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Address Line | 4815 SHARPE RD
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City | ANACORTES
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State | WA
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Zip | 98221-8403
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Country | US
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Telephone | 360-770-1752
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | CONNIE COLLEEN WYATT
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Credential | OTR/L
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Telephone | 360-770-1752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XE0001X
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Taxonomy Name | Environmental Modification Occupational Therapist
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License Number |
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License Number State |
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