1235285347 NPI number — BOTHELL PEDIATRIC & HAND THERAPY

Table of content: (NPI 1235285347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235285347 NPI number — BOTHELL PEDIATRIC & HAND THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOTHELL PEDIATRIC & HAND THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235285347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18504 BOTHELL WAY NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-481-1933
Provider Business Mailing Address Fax Number:
425-481-9371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18504 - BOTHELL WAY NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOTHELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-481-1933
Provider Business Practice Location Address Fax Number:
425-481-9371
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALQUIST
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
425-481-1933

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00007305 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X , with the licence number: PT00008794 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: OT00001174 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , with the licence number: OT00001174 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OT00002828 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: LL00004467 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8432916 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7128762 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8430985 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7682149 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8399354 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7124241 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8399347 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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