Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OC60612353 | WA |
NPI | 1013466473 |
---|---|
Provider Name | Tammi Haseltine |
First Address | Lynnwood, WA 98036-4612 |
Second Address | Lynnwood, WA 98036-4612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2016 |
Last Update Date | 27/09/2016 |