Basic Information
| Provider Information | |||||||||
| NPI: | 1124440797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIGIL-BINGMAN | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19226 E RIVER WALK LN | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990168404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087914535 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1242 11TH ST | ||||||||
| Address2: | |||||||||
| City: | CLARKSTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 994032815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097582523 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2014 | ||||||||
| LastUpdateDate: | 01/15/2014 | ||||||||
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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 | 225X00000X | OT 60432125 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.