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General NPI Number Information
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NPI Number | 1790210854
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Entity Type | Individual
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Provider Name | ELIZABETH PACKARD CISNEROS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 1601 E YESLER WAY
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City | SEATTLE
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State | WA
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Zip | 98122-5640
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Country | US
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Telephone | 206-313-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 9444 14TH AVE SW
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City | SEATTLE
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State | WA
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Zip | 98106-2811
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Country | US
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Telephone | 925-286-1341
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 60729894
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License Number State | WA
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