Healthcare Provider Details

I. General information

NPI: 1699433300
Provider Name (Legal Business Name): SOUTH SOUND PEDIATRIC OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4226 N BRISTOL ST
TACOMA WA
98407-1905
US

IV. Provider business mailing address

4226 N BRISTOL ST
TACOMA WA
98407-1905
US

V. Phone/Fax

Practice location:
  • Phone: 253-208-7042
  • Fax: 253-292-6739
Mailing address:
  • Phone: 253-208-7042
  • Fax: 253-292-6739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MACKENZIE RAE ZAKHAROV
Title or Position: OWNER/PROVIDER
Credential: OT
Phone: 253-208-7042