Individual
TARA DEWAELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
12033 SE 256TH ST, KENT, WA 98030-6503
(253) 373-7513
Mailing address
12033 SE 256TH ST, KENT, WA 98030-6503
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OC00001040
WA
Other
Enumeration date
09/25/2012
Last updated
09/25/2012
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