Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT60167274 | WA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT60167274 | WA |
NPI | 1194038109 |
---|---|
Provider Name | Jessica Ann Garrett |
First Address | Bothell, WA 98011-1927 |
Second Address | Bothell, WA 98011-1927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2010 |
Last Update Date | 17/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0277404 | DEPT OF L&I (01) | WA |
0277416 | DEPT OF L&I (01) | WA |
0277421 | DEPT OF L&I (01) | WA |