1356414981 NPI number — ROBIN ELIZABETH BRADBURY VANHOUTEN O.T.R./L.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356414981 NPI number — ROBIN ELIZABETH BRADBURY VANHOUTEN O.T.R./L.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANHOUTEN
Provider First Name:
ROBIN ELIZABETH
Provider Middle Name:
BRADBURY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.T.R./L.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRADBURY
Provider Other First Name:
ROBIN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.T.R./L.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356414981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 S SHERMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99202-4918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-755-8511
Provider Business Mailing Address Fax Number:
999-999-9999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1013 E COEUR DALENE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-4121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-755-8511
Provider Business Practice Location Address Fax Number:
999-999-9999
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT00004340 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0200X , with the licence number: OT-746 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)