Provider Demographics
NPI:1376758805
Name:RONQUILLO, ELAINE (OTR)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:RONQUILLO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4259 WOODLAND PARK AVE N
Mailing Address - Street 2:APT #5
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7449
Mailing Address - Country:US
Mailing Address - Phone:703-625-4331
Mailing Address - Fax:
Practice Address - Street 1:4259 WOODLAND PARK AVE N
Practice Address - Street 2:APT #5
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7449
Practice Address - Country:US
Practice Address - Phone:703-625-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003427225X00000X
WAOT00004118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist