Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT61134324 | WA |
NPI | 1033792528 |
---|---|
Provider Name | Shaina Marie Bass |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2021 |
Last Update Date | 05/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT61134324 | WA OT LICENSE NUMBER (01) | WA |