Pacific Kids Pediatric Therapy, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

OT00002502 Issued in WA

Legal business name

PACIFIC KIDS PEDIATRIC THERAPY, LLC

Practice address

148 Harborview Drive
Bellingham, WA 98229

Phone

(360) 393-6210

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Shelly Brask, OTRLNPI 1922159755

Title

Occupational Therapist

Phone

(360) 393-6210

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Shelly Brask, OTRL

  • Pediatric Occupational Therapist
  • Bellingham, WA
  • NPI 1922159755
  NPD (past) Authorized official

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1962556258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11009",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985081009",
            "telephone_number": "360-393-6210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 HARBORVIEW DRIVE",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "98229",
            "telephone_number": "360-393-6210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC KIDS PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "BRASK",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "360-393-6210",
        "authorized_official_credential": "OTRL"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "OT00002502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7683923",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; 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.