Provider Demographics
NPI:1972844900
Name:MACKINDER, VICTORIA LYNN (OT)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LYNN
Last Name:MACKINDER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:LYNN
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:9315 GRAVELLY LAKE DR SW
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1574
Mailing Address - Country:US
Mailing Address - Phone:253-581-5200
Mailing Address - Fax:253-581-5203
Practice Address - Street 1:8011 112TH STREET CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-7814
Practice Address - Country:US
Practice Address - Phone:253-848-0662
Practice Address - Fax:253-848-8567
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60341665225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0307022OtherL&I PROVIDER ID
WAG8917969Medicare PIN