Basic Information
| Provider Information | |||||||||
| NPI: | 1699989210 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHWEST HAND THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2820 GRIFFIN AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980222373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608026838 | ||||||||
| FaxNumber: | 3608026839 | ||||||||
| Practice Location | |||||||||
| Address1: | 2820 GRIFFIN AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980222373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608026838 | ||||||||
| FaxNumber: | 3608026839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 10/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | LOUIE | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3608026838 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | OT00002354 | WA | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 4749320001 | 01 | WA | DMERC | OTHER |