Healthcare Provider Details

I. General information

NPI: 1548514052
Provider Name (Legal Business Name): TRICIA SUZANNE WHITE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 E GREEN LAKE WAY N
SEATTLE WA
98103-5439
US

IV. Provider business mailing address

4560 SE INTERNATIONAL WAY STE. 100
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-9666
  • Fax: 971-206-5203
Mailing address:
  • Phone: 971-206-5200
  • Fax: 971-206-5203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOC60210873
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: