Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT 00003327 | WA |
NPI | 1215324538 |
---|---|
Provider Name | Angeleigh Gregorios |
First Address | Redmond, WA 98074-3343 |
Second Address | Redmond, WA 98052-4245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2015 |
Last Update Date | 24/04/2015 |