Provider Demographics
NPI:1053860635
Name:DAFFODIL VALLEY CHILDREN'S THERAPY
Entity Type:Organization
Organization Name:DAFFODIL VALLEY CHILDREN'S THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,OTR/L
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:253-283-5181
Mailing Address - Street 1:1206 13TH ST SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7004
Mailing Address - Country:US
Mailing Address - Phone:253-283-5181
Mailing Address - Fax:
Practice Address - Street 1:205 15TH AVE SW
Practice Address - Street 2:SUITE B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371
Practice Address - Country:US
Practice Address - Phone:253-283-5181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004441225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty