Provider Demographics
NPI:1932447380
Name:AGUSEVICH, RUSLANA A
Entity Type:Individual
Prefix:
First Name:RUSLANA
Middle Name:A
Last Name:AGUSEVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 106TH AVE NE APT A217
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4676
Mailing Address - Country:US
Mailing Address - Phone:206-859-8685
Mailing Address - Fax:
Practice Address - Street 1:1032 106TH AVE NE APT A217
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4676
Practice Address - Country:US
Practice Address - Phone:206-859-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60076279225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist