Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT00000365 | WA |
N | 225XH1200X | Occupational Therapist - Hand | 9105000003 | WA |
NPI | 1285764043 |
---|---|
Provider Name | Mrs. Lynnlee Fullenwider |
First Address | Kirkland, WA 98034-3025 |
Second Address | Kirkland, WA 98034-3025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 29/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0282300 | L & I (01) | WA |
0282315 | L & I (01) | WA |
0282323 | L & I (01) | |
34464 | L & I (01) | WA |
7680697 | (05) | WA |
FU4123 | REGENCE (01) | WA |