Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT0000730 | WA |
NPI | 1194752469 |
---|---|
Provider Name | Carolyn Yatsu Wyble |
First Address | Mukilteo, WA 98275-4618 |
Second Address | Everett, WA 98201-4147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 08/07/2007 |