Basic Information
Provider Information | |||||||||
NPI: | 1073798815 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PACIFIC HANDWORKS INC., P.S. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2800 NORTHUP WAY | ||||||||
Address2: | 200 | ||||||||
City: | BELLEVUE | ||||||||
State: | WA | ||||||||
PostalCode: | 980041440 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4258275877 | ||||||||
FaxNumber: | 4258275843 | ||||||||
Practice Location | |||||||||
Address1: | 2800 NORTHUP WAY | ||||||||
Address2: | 200 | ||||||||
City: | BELLEVUE | ||||||||
State: | WA | ||||||||
PostalCode: | 980041440 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4258275877 | ||||||||
FaxNumber: | 4258275843 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/28/2007 | ||||||||
LastUpdateDate: | 12/28/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WALKER | ||||||||
AuthorizedOfficialFirstName: | LISA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OCCUPATIONAL HAND THERAPIST | ||||||||
AuthorizedOfficialTelephone: | 4258275877 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MOTR/L | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0401X | OT00003732 | WA | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
ID Information
ID | Type | State | Issuer | Description | 8943244 | 01 | WA | DEPT OF L&I CRIME VICTIM | OTHER | 0188428 | 01 | WA | DEPT LABOR & INDUSTRIES | OTHER | 7460507 | 01 | WA | AETNA | OTHER | 2082981 | 01 | WA | FIRST HEALTH | OTHER |