Provider Demographics
NPI:1982927034
Name:AVERY, ALICE (LMT, COTA)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:LMT, COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 12TH AVE S APT 308
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-7413
Mailing Address - Country:US
Mailing Address - Phone:503-901-3799
Mailing Address - Fax:
Practice Address - Street 1:6965 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1953
Practice Address - Country:US
Practice Address - Phone:425-677-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60107872225700000X
WAOC60996364224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist