Provider Demographics
NPI:1447852538
Name:ENDRESEN, ALICIA C (COTA/L)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:C
Last Name:ENDRESEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 146TH PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-8982
Mailing Address - Country:US
Mailing Address - Phone:425-870-0367
Mailing Address - Fax:
Practice Address - Street 1:20818 44TH AVE W STE 270
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7709
Practice Address - Country:US
Practice Address - Phone:425-672-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60921197224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant