Organization
LEAPS AND BOUNDS PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILSE MULLEN (OT)
(360) 878-8734
Entity
Organization
Contact information
Practice address
3231 WILLAMETTE DR NE STE A, LACEY, WA 98516-1378
(360) 878-8734
Mailing address
3231 WILLAMETTE DR NE STE A, LACEY, WA 98516-1378
(360) 878-8734
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT00003784
LICENSE #
WA
Enumeration date
10/08/2020
Last updated
10/08/2020
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