Basic Information
| Provider Information | |||||||||
| NPI: | 1114026648 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC HANDWORKS INC., P.S. | ||||||||
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| 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: | 09/21/2006 | ||||||||
| LastUpdateDate: | 02/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | VALLON | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4258275877 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | OTR/L, CHT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0401X | OT00000695 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
ID Information
| ID | Type | State | Issuer | Description | 5477383 | 01 | WA | AETNA | OTHER | VA0026 | 01 | WA | REGENCE | OTHER | 8340119 | 05 | WA | MEDICAID | 0000026062702 | 01 | WA | UNITED HEALTHCARE | OTHER | 55951 | 01 | WA | DEPT OF LABOR & INDUSTRIE | OTHER |