Provider Demographics
NPI:1124565825
Name:LEAPS AND BOUNDS OF WASHINGTON
Entity Type:Organization
Organization Name:LEAPS AND BOUNDS OF WASHINGTON
Other - Org Name:LEAPS AND BOUNDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUIZINGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-677-0276
Mailing Address - Street 1:505 BROADWAY E
Mailing Address - Street 2:#398
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5023
Mailing Address - Country:US
Mailing Address - Phone:425-677-0276
Mailing Address - Fax:
Practice Address - Street 1:505 BROADWAY E
Practice Address - Street 2:#398
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5023
Practice Address - Country:US
Practice Address - Phone:425-677-0276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT600023105225X00000X
HI1397225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty