Provider Demographics
NPI:1447269196
Name:OTTAVIANI, WILLIAM E (MS, PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:OTTAVIANI
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39618 MERIDIAN E
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-9041
Mailing Address - Country:US
Mailing Address - Phone:360-832-8875
Mailing Address - Fax:
Practice Address - Street 1:39618 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328-9041
Practice Address - Country:US
Practice Address - Phone:360-832-8875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist