Provider Demographics
NPI: | 1932983574 |
---|---|
Name: | ANCHORED OCCUPATIONAL THERAPY |
Entity Type: | Organization |
Organization Name: | ANCHORED OCCUPATIONAL THERAPY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHRISTI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SHELLEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OTR/L, MSOT |
Authorized Official - Phone: | 509-953-3079 |
Mailing Address - Street 1: | 23903 E JOSEPH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | OTIS ORCHARDS |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 99027-9777 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 509-953-3079 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 23903 E JOSEPH AVE |
Practice Address - Street 2: | |
Practice Address - City: | OTIS ORCHARDS |
Practice Address - State: | WA |
Practice Address - Zip Code: | 99027-9777 |
Practice Address - Country: | US |
Practice Address - Phone: | 509-953-3079 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-08-23 |
Last Update Date: | 2023-08-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Single Specialty |