Provider Demographics
NPI:1922710664
Name:RAINBOW PEDIATRIC OCCUPATIONAL THERAPY PLLC
Entity Type:Organization
Organization Name:RAINBOW PEDIATRIC OCCUPATIONAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:425-686-9177
Mailing Address - Street 1:6523 CALIFORNIA AVE SW # 350
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1833
Mailing Address - Country:US
Mailing Address - Phone:425-686-9177
Mailing Address - Fax:
Practice Address - Street 1:6722 34TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-4208
Practice Address - Country:US
Practice Address - Phone:425-686-9177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty