1013909720 NPI number — MS. SANDRA E TETER OT, CHT

Table of content: MS. SANDRA E TETER OT, CHT (NPI 1013909720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013909720 NPI number — MS. SANDRA E TETER OT, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TETER
Provider First Name:
SANDRA
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OT, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHOMIAK
Provider Other First Name:
SANDRA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT, CHT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013909720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4220 132ND ST SE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MILL CREEK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98012-8999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-357-9380
Provider Business Mailing Address Fax Number:
425-357-9382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9411 192ND AVE E BLDG D
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391-8564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-268-5105
Provider Business Practice Location Address Fax Number:
253-258-3298
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT00001042 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 185877 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8376683 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00403555 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 6162TE . This is a "REGENCE BS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8938039 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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