Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT00002797 | WA |
NPI | 1245272632 |
---|---|
Provider Name | Ms. Suzanne L. Dervin |
First Address | Seattle, WA 98104-1172 |
Second Address | Mount Vernon, WA 98274-6033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 30/12/2013 |