Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | TL60016282 | WA |
NPI | 1003074949 |
---|---|
Provider Name | Ms. Mary Patricia Dodge |
First Address | Seattle, WA 98102-4728 |
Second Address | Seattle, WA 98195-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2008 |
Last Update Date | 28/05/2008 |