Basic Information
| Provider Information | |||||||||
| NPI: | 1255516092 | ||||||||
| 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: | 12/28/2007 | ||||||||
| LastUpdateDate: | 12/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | MOODALY | ||||||||
| AuthorizedOfficialFirstName: | KALAIVANI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL HAND THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4258275877 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | OTR/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0401X | OT00002234 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
ID Information
| ID | Type | State | Issuer | Description | 9260MO | 01 | WA | REGENCE | OTHER | 0133894 | 01 | WA | LABOR AND INDUSTRIES | OTHER | 7253070 | 01 | WA | AETNA | OTHER | 8943431 | 01 | WA | L&I CRIME VICTIMS | OTHER | 8384760 | 05 | WA | MEDICAID | 2082989 | 01 | WA | FIRST HEALTH | OTHER |