MEDICARE: MS. MYRA KIM FAUST 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	00000528	WA

General Provider Information

NPI Number	:	1841546405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MYRA KIM FAUST OTR

Provider Business Mailing Address
First Line	:	4515 MARTIN LUTHER KING JR WAY S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-2182
Country	:	US
Telephone Number	:	206-320-5325
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 MARTIN LUTHER KING JR WAY S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-2182
Country	:	US
Telephone Number	:	206-320-5325
Fax Number	:

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

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	07/31/2012

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