Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT00001791 | WA |
Y | 225XH1200X | Occupational Therapist - Hand | OT00001791 | WA |
NPI | 1013119379 |
---|---|
Provider Name | Mrs. Deborah Ann Mazza |
First Address | Kirkland, WA 98034-3064 |
Second Address | Kirkland, WA 98034-3064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 02/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2127689 | (05) | WA |