Provider Demographics
NPI:1265044085
Name:FRETTE, RAINEY E (COTA/L)
Entity Type:Individual
Prefix:
First Name:RAINEY
Middle Name:E
Last Name:FRETTE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20705 PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-8111
Mailing Address - Country:US
Mailing Address - Phone:360-708-6173
Mailing Address - Fax:
Practice Address - Street 1:11252 WALKER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-7265
Practice Address - Country:US
Practice Address - Phone:360-333-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC610845333224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty