Basic Information
| Provider Information | |||||||||
| NPI: | 1578722203 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIRE | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18508 65TH ST E | ||||||||
| Address2: | |||||||||
| City: | BONNEY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983918826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538635333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6220 S ALASKA ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984081317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534765300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2008 | ||||||||
| LastUpdateDate: | 06/06/2008 | ||||||||
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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 | 00001392 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.