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Individual

MARY DOUGLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTRL, CHT

Contact information

Practice address
1112 CAROLINE ST, PORT ANGELES, WA 98362-4204
(360) 417-8630
(360) 417-8635
Mailing address
1112 CAROLINE ST, PORT ANGELES, WA 98362-4204
(360) 417-8630
(360) 417-8635

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT00003831
WA
225XH1200X
Hand Occupational Therapist
OT00003831
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0304760
L&I
WA
05
8399149
WA
Enumeration date
01/05/2007
Last updated
04/22/2013
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