Provider Demographics
NPI:1205043759
Name:VISOKER, GALI
Entity Type:Individual
Prefix:
First Name:GALI
Middle Name:
Last Name:VISOKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82897
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-0897
Mailing Address - Country:US
Mailing Address - Phone:206-364-3777
Mailing Address - Fax:206-364-3999
Practice Address - Street 1:2545 NE 200TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1417
Practice Address - Country:US
Practice Address - Phone:206-364-3777
Practice Address - Fax:206-364-3999
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003675225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7682651Medicaid