Provider Demographics
NPI:1801031679
Name:CARLSEN, INGRID V (OT)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:V
Last Name:CARLSEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-3912
Mailing Address - Country:US
Mailing Address - Phone:206-276-8076
Mailing Address - Fax:
Practice Address - Street 1:4510 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-3912
Practice Address - Country:US
Practice Address - Phone:206-276-8076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60048884174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7018518Medicaid
WA600337984Medicare PIN