Provider Demographics
NPI:1528021995
Name:FROST, RENEE M (OT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:FROST
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:ETCHAMENDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 DENNIS ST SW
Mailing Address - Street 2:STE B
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6523
Mailing Address - Country:US
Mailing Address - Phone:360-338-0181
Mailing Address - Fax:360-338-0257
Practice Address - Street 1:417 W. YELM AVE.
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7679
Practice Address - Country:US
Practice Address - Phone:360-458-2444
Practice Address - Fax:360-458-2747
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3456ETOtherREGENCE BLUE SHIELD
WA8940933OtherL & I CRIME VICTIMS
WA8341323Medicaid
WA7869553OtherAETNA
WA0206687OtherDEPT. OF LABOR & INDUSTRY
WAG8859037Medicare PIN
WA710883456-98503-A003OtherTRICARE