Provider Demographics
NPI:1043603962
Name:NELSON, ANNASTASSIA MINA WOO (MS, OT-R)
Entity Type:Individual
Prefix:MS
First Name:ANNASTASSIA
Middle Name:MINA WOO
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, OT-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 BENSON RD S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5106
Mailing Address - Country:US
Mailing Address - Phone:425-336-3260
Mailing Address - Fax:425-277-7726
Practice Address - Street 1:2640 BENSON RD S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5106
Practice Address - Country:US
Practice Address - Phone:425-336-3260
Practice Address - Fax:425-277-7726
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60538960225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist