Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
N | 2251E1200X | Ergonomics | ||
N | 225XE1200X | Ergonomics | ||
Y | 225XH1200X | Occupational Therapist - Hand | ||
N | 225XH1200X | Occupational Therapist - Hand | OT00000928 | WA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation |
NPI | 1235251745 |
---|---|
Provider Name | Carol Jean Nicholson |
First Address | Seattle, WA 98126-2723 |
Second Address | Seattle, WA 98126-3833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 25/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137579 | L & I PROVIDER NUMBER (01) | WA |
OT00000928 | OT LICENSE WA STATE (01) | WA |