Individual
KELLY TODD FLEMETAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
16635 168TH PL NE, SUITE 2, WOODINVILLE, WA 98072-8988
(206) 683-4928
(425) 481-3332
Mailing address
16635 168TH PL NE, SUITE 2, WOODINVILLE, WA 98072-8988
(206) 683-4928
(425) 481-3332
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT00003368
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007633803
AETNA PROVIDER NUMBER
WA
01
—
3153FL
REGENCE PROVIDER NUMBER
WA
01
—
351452100000
PREMERA PROVIDER NUMBER
WA
01
—
743167413
TAX IDENTIFICATION NUMBER
WA
05
—
7683683
—
WA
Enumeration date
02/13/2007
Last updated
07/16/2014
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