Provider Demographics
NPI:1073530770
Name:EYTCHISON, BROOKE (OT)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:
Last Name:EYTCHISON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-827-5877
Mailing Address - Fax:
Practice Address - Street 1:2800 NORTHUP WAY # 260
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1440
Practice Address - Country:US
Practice Address - Phone:425-827-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00003909225XP0019X
WAOT00003909225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0034EYOtherREGENCE
WA0040EYOtherREGENCE
WA0005EYOtherREGENCE
WA0257814OtherL&I
WA0273694OtherL&I
WA0297470OtherL & I
WA0016EYOtherREGENCE
WA0017EYOtherREGENCE
WA6393EYOtherREGENCE
WA0268149OtherDEPT OF L&I
WA1073530770OtherDSHS
WA0015EYOtherREGENCE
WA0005EYOtherREGENCE
WA6393EYOtherREGENCE
WAG8886895Medicare PIN