Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT 60134753 | WA |
NPI | 1780903500 |
---|---|
Provider Name | Lydia Ellen Phillips |
First Address | Spokane Valley, WA 99216-2165 |
Second Address | Spokane Valley, WA 99216-2165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2010 |
Last Update Date | 18/05/2010 |