Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | ||
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1164772166 |
---|---|
Provider Name | Mrs. Andrea K King |
First Address | Spokane, WA 99201-1219 |
Second Address | Spokane Valley, WA 99016-9489 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2012 |
Last Update Date | 17/09/2012 |