Provider Demographics
NPI:1659461341
Name:HAND THERAPY SPECIALIST, LLC
Entity Type:Organization
Organization Name:HAND THERAPY SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MENDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:360-923-5840
Mailing Address - Street 1:3621 ENSIGN RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5024
Mailing Address - Country:US
Mailing Address - Phone:360-923-5840
Mailing Address - Fax:360-459-4836
Practice Address - Street 1:3621 ENSIGN RD NE STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5024
Practice Address - Country:US
Practice Address - Phone:360-923-5840
Practice Address - Fax:360-459-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000867174400000X
WAOT00003444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7681877Medicaid
WA0137869OtherL&I GROUP NUMBER
WA7681877Medicaid
WA0137869OtherL&I GROUP NUMBER