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General NPI Number Information
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NPI Number | 1497168769
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Entity Type | Individual
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Provider Name | MR. SILVERIO NATIVIDAD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 2830 I ST NE
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City | AUBURN
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State | WA
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Zip | 98002-2410
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Country | US
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Telephone | 253-561-8086
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Fax |
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Provider Business Mailing Address
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Address Line | 21620 14TH AVE S APT I102
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City | DES MOINES
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State | WA
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Zip | 98198-8351
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Country | US
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Telephone | 206-384-3399
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OC60468830
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License Number State | WA
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