Provider Demographics
NPI:1265171078
Name:FEEDING THERAPY FOR KIDS
Entity type:Organization
Organization Name:FEEDING THERAPY FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-341-3108
Mailing Address - Street 1:4730 UNIVERSITY WAY NE STE 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12026 17TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5116
Practice Address - Country:US
Practice Address - Phone:425-686-9438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare