Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT00002561 | WA |
Y | 2251H1200X | Hand | PT00002561 | WA |
NPI | 1285697995 |
---|---|
Provider Name | Laurie Odland |
First Address | Burien, WA 98166-3003 |
Second Address | Burien, WA 98166-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 03/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0111231 | DEPT. OF LABOR&INDUSTRIES (01) | WA |
8333080 | (05) | WA |
8931809 | CRIME VICTUMS (01) | WA |
A009 | TRICARE (01) | WA |
OD5372 | REGENCE (01) | WA |