Basic Information
| Provider Information | |||||||||
| NPI: | 1073979225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OLYMPIC PENNINSULA AUTISM CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4008 NW COUNTRY LN | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983121638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326918242 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3500 NW BUCKLIN HILL RD | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983838503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603372222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2016 | ||||||||
| LastUpdateDate: | 01/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | CLEVERDON | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3603372222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | Y | Agencies | Day Training, Developmentally Disabled Services |
No ID Information.