Provider Demographics
NPI:1356692941
Name:WALBRIDGE, ELIZABETH ANN (COTA/L)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:WALBRIDGE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:WALBRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:12033 SE 256TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6503
Mailing Address - Country:US
Mailing Address - Phone:253-373-7664
Mailing Address - Fax:
Practice Address - Street 1:12033 SE 256TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6503
Practice Address - Country:US
Practice Address - Phone:253-373-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 00000326224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant