Individual
NICOLE JOYCE D LASQUETE BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
12033 SE 256TH ST, KENT, WA 98030-6643
(253) 373-7030
Mailing address
19021 EAGLE RIDGE DR E, BONNEY LAKE, WA 98391-4007
(747) 266-7823
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OC61253538
WA
Other
Enumeration date
05/30/2023
Last updated
05/30/2023
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