Healthcare Provider Details

I. General information

NPI: 1043086010
Provider Name (Legal Business Name): SHARON ANN CINNAMON OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 BROADWAY FL 2
TACOMA WA
98402-3400
US

IV. Provider business mailing address

1313 BROADWAY FL 2
TACOMA WA
98402-3400
US

V. Phone/Fax

Practice location:
  • Phone: 253-878-4868
  • Fax:
Mailing address:
  • Phone: 253-878-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0C60329826
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: