Provider Demographics
NPI:1720785611
Name:DERKSEN, LOUISE CHRISTINE GABRIELLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:CHRISTINE GABRIELLE
Last Name:DERKSEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32782 NE 52ND ST
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-5002
Mailing Address - Country:US
Mailing Address - Phone:425-445-8300
Mailing Address - Fax:
Practice Address - Street 1:4206 336TH PL SE
Practice Address - Street 2:
Practice Address - City:FALL CITY
Practice Address - State:WA
Practice Address - Zip Code:98024-5103
Practice Address - Country:US
Practice Address - Phone:425-830-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC61191865224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant