Basic Information
| Provider Information | |||||||||
| NPI: | 1992817001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESCHENES | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 MADISON ST | ||||||||
| Address2: | SUITE 901 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981041172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062648100 | ||||||||
| FaxNumber: | 2062648689 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 S LAVENTURE RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982746033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604242400 | ||||||||
| FaxNumber: | 3604242418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT00001264 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | OT00001264 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 0222959 | 01 | WA | DEPARTMENT OF L&I | OTHER | R10001 | 01 | WA | REGENCE BLUE SHIELD | OTHER | 0222958 | 01 | WA | DEPARTMENT OF L&I | OTHER | 9115DE | 01 | WA | REGENCE/BLUE SHIELD | OTHER | 7073209 | 01 | WA | AETNA | OTHER | 8487928 | 01 | WA | DSHS | OTHER | 72843 | 01 | WA | LABOR & INDUSTRIES | OTHER | 8944931 | 01 | WA | L&I CRIME VICTIMS | OTHER | 7728DE | 01 | WA | REGENCE/BLUE SHIELD | OTHER | 7680465 | 05 | WA | MEDICAID |