NPIMap

Organization Active NPI

Eastside Hand Rehabilitation Clinic Inc

  • Occupational Therapist
  • Kirkland, WA
National Provider Identifier
1467582320
Registry record updated Dec 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
EASTSIDE HAND REHABILITATION CLINIC INC
Practice address
12911-120TH Ave NE
Suite F-120
Kirkland, WA 98034-3025
Phone
(425) 823-1389
Fax
(425) 820-3996
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2009

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

Authorized official

Name
Mrs. Lynnlee Fullenwider, OTRL CHTNPI 1285764043
Title
Owner President
Phone
(425) 823-1389

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary
Hand Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XH1200X

Addresses

Primary practice location

12911-120TH Ave NE
Suite F-120
Kirkland, WA 98034-3025

Mailing address

12911-120TH Ave NE
Suite F-120
Kirkland, WA 98034-3025
Phone (425) 823-1389

Other identifiers 4

IdentifierTypeStateIssuer
EA2218OtherWAREGENCE
7680697MedicaidWA
T06695OtherWAPREMERA
34460OtherWAL & I

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260316800000",
    "number": "1467582320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12911-120TH AVE NE",
            "address_2": "SUITE F-120",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343025",
            "telephone_number": "425-823-1389",
            "fax_number": "425-820-3996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12911-120TH AVE NE",
            "address_2": "SUITE F-120",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343025",
            "telephone_number": "425-823-1389",
            "fax_number": "425-820-3996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE HAND REHABILITATION CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2009-12-09",
        "status": "A",
        "authorized_official_last_name": "FULLENWIDER",
        "authorized_official_first_name": "LYNNLEE",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "425-823-1389",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTRL CHT"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Hand",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "EA2218",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7680697",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA",
            "identifier": "T06695",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "34460",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2009; 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.