Provider Demographics
NPI:1568718310
Name:PETRIE, TREVOR W (OTR/L, CHT)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:W
Last Name:PETRIE
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 120TH AVE NE STE H220
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3064
Mailing Address - Country:US
Mailing Address - Phone:425-823-4224
Mailing Address - Fax:425-820-8975
Practice Address - Street 1:12911 120TH AVE NE STE H220
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-823-4224
Practice Address - Fax:425-820-8975
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60281894225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022316Medicaid
WA0297907OtherL & I
WA0297858OtherL & I
WAG8912285Medicare PIN
WA0297907OtherL & I
WA0297858OtherL & I
WAG8912284Medicare PIN