Provider Demographics
NPI:1437628237
Name:OU, WENTAO
Entity Type:Individual
Prefix:
First Name:WENTAO
Middle Name:
Last Name:OU
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 1:1100 NE 47TH ST APT 411
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4688
Mailing Address - Country:US
Mailing Address - Phone:206-890-9583
Mailing Address - Fax:
Practice Address - Street 1:4746 11TH AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4660
Practice Address - Country:US
Practice Address - Phone:206-535-8876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
103K00000XOtherBEHAVIOR ANALYST