Provider Demographics
NPI:1275720500
Name:SHULTZ, BARBARA A (OTR)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:A
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1916 PIKE PL
Mailing Address - Street 2:SUITE 12, # 163
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1056
Mailing Address - Country:US
Mailing Address - Phone:503-703-7198
Mailing Address - Fax:877-703-8770
Practice Address - Street 1:710 6TH ST
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350
Practice Address - Country:US
Practice Address - Phone:503-703-7198
Practice Address - Fax:877-703-8770
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007569225X00000X
225X00000X
WA60475842225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1275720500Medicaid
WA1275720500Medicare PIN