Provider Demographics
NPI:1841577442
Name:DIDILESCU, MICAYLA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MICAYLA
Middle Name:
Last Name:DIDILESCU
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12215 NE 165TH PL
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-7128
Mailing Address - Country:US
Mailing Address - Phone:605-310-1167
Mailing Address - Fax:
Practice Address - Street 1:20818 44TH AVE W STE 270
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7709
Practice Address - Country:US
Practice Address - Phone:877-497-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60215496225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist