Healthcare Provider Details

I. General information

NPI: 1396354924
Provider Name (Legal Business Name): SARAH KUISMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 W BROADWAY AVE # 1
MOSES LAKE WA
98837-2676
US

IV. Provider business mailing address

20662 ROAD A.3 NW
SOAP LAKE WA
98851-9651
US

V. Phone/Fax

Practice location:
  • Phone: 509-707-0336
  • Fax:
Mailing address:
  • Phone: 218-616-0151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: