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NPI Code Detail

MEDICARE: SUSAN BROADHURST OT

MEDICARE: SUSAN BROADHURST OT
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
1225X00000XOccupational TherapistOT0001772WA
2225X00000XOccupational Therapist984994OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OT00001772OTHERWAWASHINGTON DEPARTMENT OF HEALTH
2984994OTHEROROREGON DEPARTMENT OF HEALTH

General Provider Information

NPI Number : 1245562172
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN BROADHURST OT
Provider Business Mailing Address
First Line : 4515 MARTIN LUTHER KING JR WAY S
Second Line : SUITE 100
City : SEATTLE
State : WA
Zip : 98108-2182
Country : US
Telephone Number : 206-325-5325
Fax Number : 206-325-5326
Provider Business Practice Location Address
First Line : 4515 MARTIN LUTHER KING JR WAY S
Second Line : SUITE 100
City : SEATTLE
State : WA
Zip : 98108-2182
Country : US
Telephone Number : 206-325-5325
Fax Number : 206-325-5326
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2010
Last Update Date : 02/03/2010

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