Provider Demographics
NPI:1205081056
Name:MULAMBA, HARON E (OTR)
Entity type:Individual
Prefix:MR
First Name:HARON
Middle Name:E
Last Name:MULAMBA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:MR
Other - First Name:HARON
Other - Middle Name:MULAMBA
Other - Last Name:ELKANAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:2204 W LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2733
Mailing Address - Country:US
Mailing Address - Phone:509-766-7036
Mailing Address - Fax:
Practice Address - Street 1:817 E PLUM ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1870
Practice Address - Country:US
Practice Address - Phone:509-256-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist