Individual
MICK PHRAKONEKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OC60942789
Contact information
Practice address
2717 DEXTER AVE N, SEATTLE, WA 98109-1914
(206) 284-7012
Mailing address
25117 SW PARKWAY AVE, WILSONVILLE, OR 97070-9697
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
04/27/2019
Last updated
04/27/2019
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