Provider Demographics
NPI:1598959785
Name:ADAPTABLE FOR LIFE
Entity Type:Organization
Organization Name:ADAPTABLE FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DEROSA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:206-403-0190
Mailing Address - Street 1:PO BOX 20486
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-1486
Mailing Address - Country:US
Mailing Address - Phone:206-403-0190
Mailing Address - Fax:
Practice Address - Street 1:526 YALE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5542
Practice Address - Country:US
Practice Address - Phone:206-403-0190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004111225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty