Provider Demographics
NPI:1912058199
Name:SPOELHOF, RENEE L (OT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:L
Last Name:SPOELHOF
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000916225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS0863340OtherAETNA SPECIALIST PIN
WAP00095376OtherRAILROAD MC#
WA0039584OtherLABOR AND INDUSTRIES #
WA8348328Medicaid
WASP8074OtherBLUE SHIELD #
WASP8074OtherBLUE SHIELD #
WA8802281Medicare PIN
WAUS0863340OtherAETNA SPECIALIST PIN