Provider Demographics
NPI:1285970566
Name:CARTMELL DEMERRITT, ELICIA MAUREEN (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:ELICIA
Middle Name:MAUREEN
Last Name:CARTMELL DEMERRITT
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20922 64TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-6043
Mailing Address - Country:US
Mailing Address - Phone:509-430-5772
Mailing Address - Fax:
Practice Address - Street 1:1601 AVENUE D
Practice Address - Street 2:SNOHOMISH SCHOOL DISTRICT
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1799
Practice Address - Country:US
Practice Address - Phone:360-563-7308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00004518225X00000X, 225XP0200X
WA45528OH225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics