MEDICARE: LEAPS AND BOUNDS OF WASHINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1397	HI
2	225X00000X	Occupational Therapist	OT600023105	WA

General Provider Information

NPI Number	:	1124565825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAPS AND BOUNDS OF WASHINGTON

Provider Business Mailing Address
First Line	:	505 BROADWAY E
Second Line	:	#398
City	:	SEATTLE
State	:	WA
Zip	:	98102-5023
Country	:	US
Telephone Number	:	425-677-0276
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 BROADWAY E
Second Line	:	#398
City	:	SEATTLE
State	:	WA
Zip	:	98102-5023
Country	:	US
Telephone Number	:	425-677-0276
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JAMIE HUIZINGA
Credential	:
Telephone Number	:	425-677-0276

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	01/20/2017

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Directions to “LEAPS AND BOUNDS OF WASHINGTON ” Practice Location

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