Provider Demographics
NPI:1790039170
Name:MASON, VICKI ANN (OT/L)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:ANN
Last Name:MASON
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 200TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-6627
Mailing Address - Country:US
Mailing Address - Phone:425-431-3055
Mailing Address - Fax:425-431-7511
Practice Address - Street 1:8500 200TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-6627
Practice Address - Country:US
Practice Address - Phone:425-431-3055
Practice Address - Fax:425-431-7511
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003215225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist