Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OC00000615 | WA |
NPI | 1033352422 |
---|---|
Provider Name | Mary Jane Lebeau |
First Address | Auburn, WA 98002-6822 |
Second Address | Auburn, WA 98002-6822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2009 |
Last Update Date | 14/04/2009 |