Provider Demographics
NPI:1568603587
Name:FULWILER, NITA (COTA L/R)
Entity Type:Individual
Prefix:
First Name:NITA
Middle Name:
Last Name:FULWILER
Suffix:
Gender:F
Credentials:COTA L/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5937
Mailing Address - Country:US
Mailing Address - Phone:425-226-4610
Mailing Address - Fax:
Practice Address - Street 1:80 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5937
Practice Address - Country:US
Practice Address - Phone:425-226-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-21
Last Update Date:2009-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant