Provider Demographics
NPI:1568126811
Name:VAN DER MEULEN, CAROLYN (OTD, OTR)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:VAN DER MEULEN
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19221 36TH AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5700
Mailing Address - Country:US
Mailing Address - Phone:425-774-9564
Mailing Address - Fax:
Practice Address - Street 1:19221 36TH AVE W STE 101
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5700
Practice Address - Country:US
Practice Address - Phone:425-774-9564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist