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General NPI Number Information
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NPI Number | 1164787685
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Entity Type | Organization
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Legal Business Name | PIONEER THERAPY CENTER PLLC
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 324 E PIONEER
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City | PUYALLUP
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State | WA
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Zip | 98372-3264
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Country | US
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Telephone | 253-377-6285
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Fax | 253-693-2016
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Provider Business Mailing Address
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Address Line | 324 E PIONEER
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City | PUYALLUP
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State | WA
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Zip | 98372-3264
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Country | US
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Telephone | 253-377-6285
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Fax | 253-693-2016
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Authorized Official
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Title or Position | PRESIDENT / OT THERAPIST
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Name | KAREN WITTERS
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Credential | OT
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Telephone | 253-377-6285
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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 | OT00000593
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License Number State | WA
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