Provider Demographics
NPI:1003576257
Name:FIDALGO ISLAND PEDIATRIC OCCUPATIONAL THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:FIDALGO ISLAND PEDIATRIC OCCUPATIONAL THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:206-819-3905
Mailing Address - Street 1:2116 MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-1170
Mailing Address - Country:US
Mailing Address - Phone:206-819-3905
Mailing Address - Fax:
Practice Address - Street 1:2116 MEADOWS LN
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-1170
Practice Address - Country:US
Practice Address - Phone:206-819-3905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center