Organization
EASTSIDE HAND REHABILITATION CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LYNNLEE FULLENWIDER OTRL CHT (OWNER PRESIDENT)
(425) 823-1389
Entity
Organization
Contact information
Practice address
12911-120TH AVE NE, SUITE F-120, KIRKLAND, WA 98034-3025
(425) 823-1389
(425) 820-3996
Mailing address
12911-120TH AVE NE, SUITE F-120, KIRKLAND, WA 98034-3025
(425) 823-1389
(425) 820-3996
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
225XH1200X
Hand Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34460
L & I
WA
05
—
7680697
—
WA
01
—
EA2218
REGENCE
WA
01
—
T06695
PREMERA
WA
Enumeration date
03/07/2007
Last updated
12/09/2009
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