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General NPI Number Information
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NPI Number | 1710836937
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Entity Type | Individual
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Provider Name | AYUMI GOTHBERG
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Gender | Female
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Dates
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Enumeration Date | 01/22/2026
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 14900 1ST AVE NE
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City | SHORELINE
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State | WA
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Zip | 98155-6800
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Country | US
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Telephone | 206-279-3448
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Fax |
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Provider Business Mailing Address
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Address Line | 2613 NW 86TH ST
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City | SEATTLE
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State | WA
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Zip | 98117-3838
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Country | US
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Telephone |
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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 | OT.OT.70052251
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License Number State | WA
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