Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1023787959 |
---|---|
Provider Name | Priscilla Gollen |
First Address | Kent, WA 98030-7108 |
Second Address | Kent, WA 98030-7108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2021 |
Last Update Date | 13/09/2021 |