Provider Demographics
NPI:1912074014
Name:GRIFFIN, MARY HUGHES (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HUGHES
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24269
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-1269
Mailing Address - Country:US
Mailing Address - Phone:253-874-5445
Mailing Address - Fax:253-874-0687
Practice Address - Street 1:35535 6TH PL SW
Practice Address - Street 2:BIRTH TO THREE DEVELOPMENTAL CENTER
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023
Practice Address - Country:US
Practice Address - Phone:253-874-5445
Practice Address - Fax:253-874-0687
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8367666Medicaid
GR5126OtherREGENCE BS
AA237263OtherNATIONAL BD FOR CERTIFICA