Individual
MS. SUSAN VIVOLO I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
400 29TH ST NE, PUYALLUP, WA 98372-6774
(206) 412-9801
Mailing address
12722 SE 312TH ST APT C203, AUBURN, WA 98092-3382
(206) 412-9801
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
328588
WA
Other
Enumeration date
04/04/2017
Last updated
04/04/2017
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