Provider Demographics
NPI:1558440198
Name:CHILDREN'S THERAPY OF WOODINVILLE
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY OF WOODINVILLE
Other - Org Name:CTW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-486-7710
Mailing Address - Street 1:19021 120TH AVE NE STE 102
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-9511
Mailing Address - Country:US
Mailing Address - Phone:425-486-7710
Mailing Address - Fax:425-483-6059
Practice Address - Street 1:19021 120TH AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-9511
Practice Address - Country:US
Practice Address - Phone:425-486-7710
Practice Address - Fax:425-483-6059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S THERAPY OF WOODINVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 2251P0200X, 225XP0200X, 235Z00000X
WAPT000010282251P0200X
WAPT000072122251P0200X
WAPT000050022251P0200X
WAPT000021122251P0200X
WAOT00003722225X00000X
WALL00002375235Z00000X
WALL00003980235Z00000X
WALL00003905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7681810Medicaid
WA7056815Medicaid
WA7097181Medicaid