Healthcare Provider Details

I. General information

NPI: 1932905148
Provider Name (Legal Business Name): CHARLIE STREAR OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4636 E MARGINAL WAY S STE B100
SEATTLE WA
98134-2322
US

IV. Provider business mailing address

4636 E MARGINAL WAY S STE B100
SEATTLE WA
98134-2322
US

V. Phone/Fax

Practice location:
  • Phone: 206-763-0352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.OT.70161717
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: