MEDICARE: OCCUPATIONAL HEALTH CENTERS OF WASHINGTON, P.S.

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	261QX0100X	Occupational Medicine Clinic/Center
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1386127181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL HEALTH CENTERS OF WASHINGTON, P.S.

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DRIVE
Second Line	:	SUITE 1200 WEST
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:	972-364-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 4TH AVE N STE 150
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-4940
Country	:	US
Telephone Number	:	206-682-7418
Fax Number	:	206-623-0884

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JOHN R ANDERSON
Credential	:	DO
Telephone Number	:	972-364-8000

Provider Enumeration Date	:	09/08/2018
Last Update Date	:	09/09/2018

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