Provider Demographics
NPI:1902569890
Name:WILLOW PEDIATRIC THERAPY PLLC
Entity Type:Organization
Organization Name:WILLOW PEDIATRIC THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:MOT OTR/L C/NDT
Authorized Official - Phone:253-200-5314
Mailing Address - Street 1:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-0742
Mailing Address - Country:US
Mailing Address - Phone:253-200-5314
Mailing Address - Fax:
Practice Address - Street 1:11904 214TH ST E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-7264
Practice Address - Country:US
Practice Address - Phone:253-200-5314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty