MEDICARE: HEIDI JO HYNES OTR/L

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	225XP0200X	Pediatric Occupational Therapist	OT00001045	WA

General Provider Information

NPI Number	:	1164799821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI JO HYNES OTR/L

Provider Business Mailing Address
First Line	:	2005 NE NORTHGATE WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-6646
Country	:	US
Telephone Number	:	206-362-1969
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 N.E. NORTHGATE WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-6646
Country	:	US
Telephone Number	:	206-362-9169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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