Basic Information
| Provider Information | |||||||||
| NPI: | 1467787069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | CTRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1660 S COLUMBIAN WAY | ||||||||
| Address2: | RCS-117-S | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981081532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067621010 | ||||||||
| FaxNumber: | 2062774744 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 S COLUMBIAN WAY | ||||||||
| Address2: | RCS-117-S | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981081532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067621010 | ||||||||
| FaxNumber: | 2062774744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2009 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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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 | 225800000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist |
No ID Information.