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NPI Code Detail

MEDICARE: MRS. KELLY ANN CLANCY OTRL, CHT, RBT

MEDICARE: MRS. KELLY ANN CLANCY OTRL, CHT, RBT
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 TherapistOT00001887WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1602-669-365OTHERWAUBI WASHINGTON STATE
2611805700OTHERFEDERAL LABOR AND INDUSTR
34020-CLOTHERWAREGENCE
40207147OTHERWASTATE LABOR AND INDUSTRIE
5262169551OTHERFEDERAL TAX ID

General Provider Information

NPI Number : 1275665234
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY ANN CLANCY OTRL, CHT, RBT
Provider Business Mailing Address
First Line : 3323 NW 71ST ST
Second Line :
City : SEATTLE
State : WA
Zip : 98117-6146
Country : US
Telephone Number : 206-508-1265
Fax Number : 206-508-1265
Provider Business Practice Location Address
First Line : 2821 NW MARKET ST STE E
Second Line :
City : SEATTLE
State : WA
Zip : 98107-5815
Country : US
Telephone Number : 206-508-1265
Fax Number : 206-508-1265
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 07/12/2009

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Directions to “ MRS. KELLY ANN CLANCY OTRL, CHT, RBT” Practice Location

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