Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT00004040 | |
Y | 225XH1200X | Occupational Therapist - Hand | OT00004040 | WA |
NPI | 1164451225 |
---|---|
Provider Name | Victor Henry Gajewski |
First Address | Everett, WA 98201 |
Second Address | Everett, WA 98201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 06/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8348286 | (05) | WA |