Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT00000491 | WA |
NPI | 1033244389 |
---|---|
Provider Name | Sara Wyckoff |
First Address | Shoreline, WA 98155-8205 |
Second Address | Shoreline, WA 98155-1261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 08/07/2007 |