Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0200X | Occupational Therapist - Pediatrics | OT60423658 | WA |
NPI | 1013318575 |
---|---|
Provider Name | Amanda Louise Lert |
First Address | Kent, WA 98030-7108 |
Second Address | Kent, WA 98030-7108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2014 |
Last Update Date | 15/09/2014 |