Provider Demographics
NPI:1306942156
Name:GODBOLE, MUKTI V (OTR/L, CHT)
Entity type:Individual
Prefix:MS
First Name:MUKTI
Middle Name:V
Last Name:GODBOLE
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 132ND ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-316-8046
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:2525 NE PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-2642
Practice Address - Country:US
Practice Address - Phone:425-686-7405
Practice Address - Fax:425-341-9041
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003106225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0356816OtherL & I
WA2064622Medicaid
WA0356877OtherL & I
WA0356816OtherL & I
WAG8953217Medicare PIN
WAG8953207Medicare PIN