Basic Information
Provider Information | |||||||||
NPI: | 1013961754 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BURROWS-HIGHT | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: | D. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | OTR/L, CHT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DANIEL | ||||||||
OtherFirstName: | ELIZABETH | ||||||||
OtherMiddleName: | D. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 4040 ORCHARD ST W | ||||||||
Address2: | SUITE 100 | ||||||||
City: | FIRCREST | ||||||||
State: | WA | ||||||||
PostalCode: | 984666606 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2535641560 | ||||||||
FaxNumber: | 2535644449 | ||||||||
Practice Location | |||||||||
Address1: | 7308 BRIDGEPORT WAY W | ||||||||
Address2: | SUITE 203 | ||||||||
City: | LAKEWOOD | ||||||||
State: | WA | ||||||||
PostalCode: | 984998000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2535828500 | ||||||||
FaxNumber: | 2535828506 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/19/2006 | ||||||||
LastUpdateDate: | 11/12/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | OT00003392 | WA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
ID | Type | State | Issuer | Description | 7308BU | 01 | WA | REGENCE | OTHER | 185469 | 01 | WA | DEPT OF L&I | OTHER | 8327744 | 05 | WA |   | MEDICAID |