Provider Demographics
NPI:1649535683
Name:FULL POTENTIAL OCCUPATIONAL THERAPY PLLC
Entity type:Organization
Organization Name:FULL POTENTIAL OCCUPATIONAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELVINA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:360-836-2557
Mailing Address - Street 1:PO BOX 61713
Mailing Address - Street 2:410 E 20TH ST
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-1713
Mailing Address - Country:US
Mailing Address - Phone:360-836-2557
Mailing Address - Fax:360-831-0108
Practice Address - Street 1:410 E 20TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3316
Practice Address - Country:US
Practice Address - Phone:360-836-2557
Practice Address - Fax:360-831-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service