Provider Demographics
NPI:1740340769
Name:MUNK, ELIZABETH MARGUERITE (MOT OTRL)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MARGUERITE
Last Name:MUNK
Suffix:
Gender:F
Credentials:MOT OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24269
Mailing Address - Street 2:BIRTH TO THREE DEVELOPMENT CENTER
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-1269
Mailing Address - Country:US
Mailing Address - Phone:253-874-5445
Mailing Address - Fax:253-874-0687
Practice Address - Street 1:35535 6TH PLACE SW
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023
Practice Address - Country:US
Practice Address - Phone:253-874-5445
Practice Address - Fax:253-874-0687
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003709225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3799MUOtherREGENCE BS
WA8367682Medicaid