Basic Information
| Provider Information | |||||||||
| NPI: | 1164988937 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GIRMA | ||||||||
| FirstName: | HENOK | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4560 SE INTERNATIONAL WAY STE 100 | ||||||||
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| City: | MILWAUKIE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972224628 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 N HIGHLANDS PKWY | ||||||||
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| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984062116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537527112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2019 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OC60927765 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.