Provider Demographics
NPI:1841286846
Name:STARNES, VICKY LEE (OT)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:LEE
Last Name:STARNES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:LEE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 3002
Mailing Address - Street 2:LONGVIEW
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-0302
Mailing Address - Country:US
Mailing Address - Phone:360-414-2048
Mailing Address - Fax:360-575-6749
Practice Address - Street 1:852 COMMERCE AVE
Practice Address - Street 2:LONGVIEW
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2406
Practice Address - Country:US
Practice Address - Phone:360-501-3750
Practice Address - Fax:360-501-3755
Is Sole Proprietor?:No
Enumeration Date:2005-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003638225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR298854Medicaid
WA8943352OtherCRIME VICTIMS
WA0172655OtherLABOR & IND.
WA8364184Medicaid
WA8943352OtherCRIME VICTIMS
WAAB38478Medicare PIN