Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 00003619 | WA |
NPI | 1043653959 |
---|---|
Provider Name | Maryanne Church Trettenero |
First Address | Federal Way, WA 98003 |
Second Address | Federal Way, WA 98003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 10/04/2013 |