Basic Information
| Provider Information | |||||||||
| NPI: | 1306870365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED REHABILITATION GROUP INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SNOHOMISH HAND THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1830 BICKFORD AVE | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | SNOHOMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982901749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253300633 | ||||||||
| FaxNumber: | 3605687779 | ||||||||
| Practice Location | |||||||||
| Address1: | 1830 BICKFORD AVE | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | SNOHOMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982901749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253300633 | ||||||||
| FaxNumber: | 3605687779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHITRIGHT | ||||||||
| AuthorizedOfficialFirstName: | PAT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC MANAGER-HAND THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3605687774 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | WA | X | Ambulatory Health Care Facilities | Clinic/Center | 225XH1200X | WA | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 0179382 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 8930199 | 01 | WA | L&I CRIME VICTIMS | OTHER | 7682230 | 05 | WA | MEDICAID | 9055039 | 05 | WA | MEDICAID | 1182780003 | 01 | WA | DME | OTHER |