Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT00004260 | WA |
N | 225XH1200X | Occupational Therapist - Hand | OT00004260 | WA |
NPI | 1144340688 |
---|---|
Provider Name | Mrs. Tracy Lea Gramer |
First Address | Edmonds, WA 98026-8006 |
Second Address | Lynnwood, WA 98036-4731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 10/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2122748 | (05) | WA |
338248 | WA LABOR & INDUSTRIES (01) | WA |