Basic Information
| Provider Information | |||||||||
| NPI: | 1073530770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EYTCHISON | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1519 132ND ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982087203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258275877 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2800 NORTHUP WAY # 260 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980041440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258275877 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 09/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0019X | OT 00003909 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | 225X00000X | OT00003909 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0034EY | 01 | WA | REGENCE | OTHER | 0040EY | 01 | WA | REGENCE | OTHER | 0005EY | 01 | WA | REGENCE | OTHER | 0257814 | 01 | WA | L&I | OTHER | 0273694 | 01 | WA | L&I | OTHER | 0297470 | 01 | WA | L & I | OTHER | 0016EY | 01 | WA | REGENCE | OTHER | 0017EY | 01 | WA | REGENCE | OTHER | 6393EY | 01 | WA | REGENCE | OTHER | 0268149 | 01 | WA | DEPT OF L&I | OTHER | 1073530770 | 01 | WA | DSHS | OTHER | 0015EY | 01 | WA | REGENCE | OTHER |