Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | TL10000815 | WA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | TL10000815 | WA |
N | 225XP0200X | Occupational Therapist - Pediatrics | TL10000815 | WA |
NPI | 1992974026 |
---|---|
Provider Name | Elizabeth Wise |
First Address | Seattle, WA 98104-2420 |
Second Address | Seattle, WA 98104-2420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2008 |
Last Update Date | 24/03/2008 |