Provider Demographics
NPI:1699016568
Name:DUNWOODY, MARYBETH AGNES (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:AGNES
Last Name:DUNWOODY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 275TH CT SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7942
Mailing Address - Country:US
Mailing Address - Phone:425-313-4630
Mailing Address - Fax:
Practice Address - Street 1:12033 SE 256TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6503
Practice Address - Country:US
Practice Address - Phone:253-373-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60299233224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant