Healthcare Provider Details

I. General information

NPI: 1457896284
Provider Name (Legal Business Name): SIERRA MINTON MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 S 48TH ST
TACOMA WA
98409-1919
US

IV. Provider business mailing address

2515 4TH AVE APT 209
SEATTLE WA
98121-1441
US

V. Phone/Fax

Practice location:
  • Phone: 253-475-4611
  • Fax:
Mailing address:
  • Phone: 360-878-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61069716
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: