Provider Demographics
NPI:1275359549
Name:VILLALOBOS PLASCENCIA, JAVIER NAYIB (COTA/L)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:NAYIB
Last Name:VILLALOBOS PLASCENCIA
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 WOODINVILLE DR TRLR 89
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3227
Mailing Address - Country:US
Mailing Address - Phone:425-691-6151
Mailing Address - Fax:
Practice Address - Street 1:17624 15TH AVE SE STE 111A
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-5107
Practice Address - Country:US
Practice Address - Phone:425-371-5698
Practice Address - Fax:425-217-5923
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC61616958224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant