Provider Demographics
NPI:1134459035
Name:EASTERN WASHINGTON UNIVERSITY - DEPT. OF OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:EASTERN WASHINGTON UNIVERSITY - DEPT. OF OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE PROFESSOR AND CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,, OTR/L
Authorized Official - Phone:509-368-6562
Mailing Address - Street 1:310 N RIVERPOINT BLVD
Mailing Address - Street 2:BOX R
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1610
Mailing Address - Country:US
Mailing Address - Phone:509-368-6560
Mailing Address - Fax:509-368-6561
Practice Address - Street 1:310 N RIVERPOINT BLVD
Practice Address - Street 2:BOX R
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1610
Practice Address - Country:US
Practice Address - Phone:509-368-6560
Practice Address - Fax:509-368-6561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center