Provider Demographics
NPI:1710373469
Name:UNDERWOOD, MARY (OTR)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9915 SANDIFUR PKWY
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8941
Mailing Address - Country:US
Mailing Address - Phone:509-546-2306
Mailing Address - Fax:509-546-2347
Practice Address - Street 1:9915 SANDIFUR PKWY
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8941
Practice Address - Country:US
Practice Address - Phone:509-546-2306
Practice Address - Fax:509-546-2347
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist