Innovative Care Clinic

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

INNOVATIVE CARE CLINIC

Practice address

1700 132ND St SE
Suite L
Mill Creek, WA 98012-5309

Phone

(425) 338-1555

Fax

(425) 338-0765

NPI assigned

Dec 9, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Fernanda Velderrain

Title

Office Manager

Phone

(425) 338-1555

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323388800000",
    "number": "1346518925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 132ND ST SE",
            "address_2": "SUITE L",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980125309",
            "telephone_number": "425-338-1555",
            "fax_number": "425-338-0765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 132ND ST SE",
            "address_2": "SUITE L",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980125309",
            "telephone_number": "425-338-1555",
            "fax_number": "425-338-0765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-09",
        "last_updated": "2011-12-09",
        "status": "A",
        "authorized_official_last_name": "VELDERRAIN",
        "authorized_official_first_name": "FERNANDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "425-338-1555",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0287152",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marisa Ruth Hun, OTR/L
• Miriam Hunt, MSW, ACSW, LCSW
• Amy Husted, LICSW
• Scott Hutsenpiller, L.M.P.
• Stella Han In, PT
• Innovative Natural Medicine PLLC
• Integrated Rehabilitation Group, PC
• Integrated Rehabilitation Group, PC (IRG Cascade Children's Therapy - Mill Creek)
• Integrated Rehabilitation Group, PC (IRG Physical Therapy - Gateway)
• Integrated Rehabilitation Group, PC (IRG Physical & Hand Therapy - Mill Creek)

• Specialist in Mill Creek, WA
• Providers in Mill Creek, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.