Organization
LIFE SPAN OCCUPATIONAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE WATSON OT (OWNER)
(425) 395-6006
Entity
Organization
Contact information
Practice address
1240 RUDDELL RD SE, LACEY, WA 98503-5747
(425) 395-6006
(360) 918-8274
Mailing address
PO BOX 4314, SPANAWAY, WA 98387-4020
(425) 395-6006
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT60105178
DEPT OF HEALTH
WA
Enumeration date
04/19/2021
Last updated
04/19/2021
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