Individual
MRS. KELLY ANN CLANCY
Active
Individual
MRS. KELLY ANN CLANCY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL, CHT, RBT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT00001887
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0207147
STATE LABOR AND INDUSTRIE
WA
01
—
262169551
FEDERAL TAX ID
—
01
—
4020-CL
REGENCE
WA
01
—
602-669-365
UBI WASHINGTON STATE
WA
01
—
611805700
FEDERAL LABOR AND INDUSTR
—
Enumeration date
03/12/2007
Last updated
07/12/2009
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