Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT00001672 | WA |
Y | 225XH1200X | Occupational Therapist - Hand | OT00001672 | WA |
NPI | 1144284324 |
---|---|
Provider Name | Ms. Beverly Andersen |
First Address | Burien, WA 98166-3003 |
Second Address | Burien, WA 98166-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 03/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0046225 | DEPT. OF LABOR&INDUSTRIES (01) | WA |
8339822 | (05) | WA |
8920943 | CRIME VICTUMS (01) | WA |
A005 | TRICARE (01) | WA |
AN4985 | REGENCE (01) | WA |