Provider Demographics
NPI:1134004518
Name:PHOMPRIDA-ROBINSON, JUWUAN
Entity type:Individual
Prefix:
First Name:JUWUAN
Middle Name:
Last Name:PHOMPRIDA-ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12530 69TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-4127
Mailing Address - Country:US
Mailing Address - Phone:206-898-8048
Mailing Address - Fax:
Practice Address - Street 1:319 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5767
Practice Address - Country:US
Practice Address - Phone:253-264-0093
Practice Address - Fax:253-264-0093
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty