Healthcare Provider Details

I. General information

NPI: 1780874958
Provider Name (Legal Business Name): JENNIFER SAMBROOK PITONYAK PHD, OTR/L, SCFES, C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S 3RD ST
YAKIMA WA
98901-2875
US

IV. Provider business mailing address

2430 223RD PL NE
SAMMAMISH WA
98074-4013
US

V. Phone/Fax

Practice location:
  • Phone: 610-724-2576
  • Fax:
Mailing address:
  • Phone: 610-724-2576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number60462832
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number60462832
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number60462832
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: