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General NPI Number Information
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NPI Number | 1013909720
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Entity Type | Individual
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Provider Name | SANDRA E TETER OT, CHT
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Gender | Female
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 9411 192ND AVE E BLDG D SUITE E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-8564
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Country | US
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Telephone | 253-268-5105
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Fax | 253-258-3298
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Provider Business Mailing Address
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Address Line | 4220 132ND ST SE SUITE 101
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City | MILL CREEK
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State | WA
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Zip | 98012-8999
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Country | US
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Telephone | 425-357-9380
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Fax | 425-357-9382
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT00001042
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License Number State | WA
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