1194877936 NPI number — TRUDY E SMITH O.T.

Table of content: TRUDY E SMITH O.T. (NPI 1194877936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194877936 NPI number — TRUDY E SMITH O.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
TRUDY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.T.
Provider Gender Code:
F

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:
1194877936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34581
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-1581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-241-7349
Provider Business Mailing Address Fax Number:
509-241-7628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10452 SILVERDALE WAY NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-9411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-307-7526
Provider Business Practice Location Address Fax Number:
360-307-7530
Provider Enumeration Date:
01/18/2007

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:  OT00002191 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8395329 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 233826 . This is a "LNI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com