Basic Information
Provider Information
NPI: 1790076305
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ESTES
FirstName: LEVI
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 421
Address2:  
City: LIBERTY LAKE
State: WA
PostalCode: 990190421
CountryCode: US
TelephoneNumber: 8667472455
FaxNumber:  
Practice Location
Address1: 16528 E DESMET CT
Address2:  
City: SPOKANE VALLEY
State: WA
PostalCode: 992163522
CountryCode: US
TelephoneNumber: 5099448920
FaxNumber: 5092277070
Other Information
ProviderEnumerationDate: 04/29/2011
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOT60223038WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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