MEDICARE: ELAINE RONQUILLO OTR

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	0119003427	VA
2	225X00000X	Occupational Therapist	OT00004118	WA

General Provider Information

NPI Number	:	1376758805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE RONQUILLO OTR

Provider Business Mailing Address
First Line	:	4259 WOODLAND PARK AVE N
Second Line	:	APT #5
City	:	SEATTLE
State	:	WA
Zip	:	98103-7449
Country	:	US
Telephone Number	:	703-625-4331
Fax Number	:

Provider Business Practice Location Address
First Line	:	4259 WOODLAND PARK AVE N
Second Line	:	APT #5
City	:	SEATTLE
State	:	WA
Zip	:	98103-7449
Country	:	US
Telephone Number	:	703-625-4331
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	05/03/2013

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Directions to “ ELAINE RONQUILLO OTR” Practice Location

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