Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1790274918 |
---|---|
Provider Name | Molly Pedersen |
First Address | Bellingham, WA 98229-7677 |
Second Address | Bellingham, WA 98229-7677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2018 |
Last Update Date | 03/05/2018 |