Provider Demographics
NPI:1235698077
Name:STUENKEL, GRETCHEN RAIN (MOTR/L)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:RAIN
Last Name:STUENKEL
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13916 SE ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1447
Mailing Address - Country:US
Mailing Address - Phone:425-998-6127
Mailing Address - Fax:
Practice Address - Street 1:8040 NE 132ND ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2522
Practice Address - Country:US
Practice Address - Phone:425-936-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60936444225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist