Provider Demographics
NPI:1114263316
Name:POON, ERIC (OT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:POON
Suffix:
Gender:M
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:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:22500 NE MARKETPLACE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-2033
Practice Address - Country:US
Practice Address - Phone:425-836-1034
Practice Address - Fax:425-836-1037
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60315434225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0303786OtherL & I
WA0303761OtherL & I
WA0303762OtherL & I
WA0303761OtherL & I
WAG8915344Medicare PIN
WAG8915342Medicare PIN
WA0303762OtherL & I