Provider Demographics
NPI:1982204509
Name:IWUANYANWU, UCHENDU EZRA (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:UCHENDU
Middle Name:EZRA
Last Name:IWUANYANWU
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 NW 47TH DR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-6856
Mailing Address - Country:US
Mailing Address - Phone:713-503-7475
Mailing Address - Fax:
Practice Address - Street 1:201 NW 78TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-7904
Practice Address - Country:US
Practice Address - Phone:360-989-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61479186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist