Organization
PACIFIC KIDS PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY BRASK OTRL (OCCUPATIONAL THERAPIST)
(360) 393-6210
Entity
Organization
Contact information
Practice address
148 HARBORVIEW DRIVE, BELLINGHAM, WA 98229
(360) 393-6210
Mailing address
PO BOX 11009, OLYMPIA, WA 98508-1009
(360) 393-6210
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
OT00002502
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7683923
—
WA
Enumeration date
01/23/2007
Last updated
07/25/2008
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