Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 00000862 | WA |
NPI | 1306146394 |
---|---|
Provider Name | Ms. Kathleen Ajax Bader |
First Address | Federal Way, WASHINGTON 998003 |
Second Address | Federal Way, WA 98003-6385 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2010 |
Last Update Date | 25/10/2010 |