Provider Demographics
NPI:1154883338
Name:NORTHWEST FISHING PARTNER REGISTRY
Entity type:Organization
Organization Name:NORTHWEST FISHING PARTNER REGISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMODORE
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIAER
Authorized Official - Suffix:
Authorized Official - Credentials:CAPT
Authorized Official - Phone:206-325-7700
Mailing Address - Street 1:9028 11TH PL W
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-2693
Mailing Address - Country:US
Mailing Address - Phone:206-325-7700
Mailing Address - Fax:
Practice Address - Street 1:9028 11TH PL W
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-2693
Practice Address - Country:US
Practice Address - Phone:206-325-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604-116-958OtherSTATE OF WASHINGTON SECRETARY OF STATE