Healthcare Provider Details

I. General information

NPI: 1003869132
Provider Name (Legal Business Name): MARIANNE HEVLY NORDEN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIANNE HEVLY OTR

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/24/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S G ST STE 4
TACOMA WA
98405-4758
US

IV. Provider business mailing address

PO BOX 7235
TACOMA WA
98417-0235
US

V. Phone/Fax

Practice location:
  • Phone: 253-465-3111
  • Fax: 253-465-3112
Mailing address:
  • Phone: 253-579-6339
  • Fax: 253-465-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00001604
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT00001604
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: