Provider Demographics
NPI:1497071344
Name:INFANTE, IRENE ELIZABETH (OT)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:ELIZABETH
Last Name:INFANTE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11128
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1128
Mailing Address - Country:US
Mailing Address - Phone:360-584-0221
Mailing Address - Fax:
Practice Address - Street 1:1805 53RD LOOP SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-8003
Practice Address - Country:US
Practice Address - Phone:360-584-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-18
Last Update Date:2010-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001630225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist