Individual
RAF CORPORAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
12033 SE 256TH ST, KENT, WA 98030-6643
(253) 373-7000
Mailing address
36443 25TH AVE S, FEDERAL WAY, WA 98003-7111
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OC61297311
WA
Other
Enumeration date
10/12/2023
Last updated
10/12/2023
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