Provider Demographics
NPI:1558471813
Name:GOLDENBERG, CAREY A (MS OTR'L)
Entity Type:Individual
Prefix:MS
First Name:CAREY
Middle Name:A
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:MS OTR'L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 E MARGINAL WAY S STE B100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-2322
Mailing Address - Country:US
Mailing Address - Phone:120-676-3035
Mailing Address - Fax:206-762-0111
Practice Address - Street 1:4636 E MARGINAL WAY S STE B100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2322
Practice Address - Country:US
Practice Address - Phone:120-676-3035
Practice Address - Fax:206-762-0111
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003262225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7683519Medicaid
WA1044731Medicaid
WA1396982385Medicaid