1255472429 NPI number — MRS. ROBYNN L OCZKEWICZ OTR/L, CHT

Table of content: MRS. ROBYNN L OCZKEWICZ OTR/L, CHT (NPI 1255472429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255472429 NPI number — MRS. ROBYNN L OCZKEWICZ OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OCZKEWICZ
Provider First Name:
ROBYNN
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STOLTE
Provider Other First Name:
ROBYNN
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L, CHT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255472429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10505 19TH AVE SE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98208-4280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3726 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-3787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-252-4600
Provider Business Practice Location Address Fax Number:
425-252-4477
Provider Enumeration Date:
02/09/2007

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: 225XH1200X , with the licence number:  OT00003685 , 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: 0279548 . This is a "L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1255472429 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G8900664 . This is a "MEDICARE NON-KING CO." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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