Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT60302480 | WA |
NPI | 1215283502 |
---|---|
Provider Name | Miss Julie Ann Ellenberger |
First Address | Seattle, WA 98104-1172 |
Second Address | Issaquah, WA 98029-5436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2012 |
Last Update Date | 24/07/2012 |