Provider Demographics
NPI:1902801970
Name:ST. DENIS, MARYBELLE (OT)
Entity Type:Individual
Prefix:MRS
First Name:MARYBELLE
Middle Name:
Last Name:ST. DENIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 NE 78TH ST
Mailing Address - Street 2:STE 9
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9668
Mailing Address - Country:US
Mailing Address - Phone:360-573-5500
Mailing Address - Fax:360-573-9075
Practice Address - Street 1:1503 NE 78TH ST
Practice Address - Street 2:STE 9
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9668
Practice Address - Country:US
Practice Address - Phone:360-573-5500
Practice Address - Fax:360-573-9075
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002543225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0157508OtherDEPT OF LABOR & INDUSTRIE
WA8937724OtherWA STATE CRIME VICTIMS
WA8369050Medicaid