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General NPI Number Information
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NPI Number | 1881979722
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Entity Type | Organization
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Legal Business Name | SIDESTIX VENTURES USA
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 410 IDA ST. WEST STE 201
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City | BREMERTON
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State | WA
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Zip | 98337
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Country | US
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Telephone | 877-464-7849
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Fax |
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Provider Business Mailing Address
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Address Line | 245 4TH ST STE 204
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City | BREMERTON
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State | WA
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Zip | 98337-5698
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Country | US
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Telephone | 877-464-7849
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SARAH JANE DOHERTY
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Credential | OT
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Telephone | 877-464-7849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 603 138 435
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License Number State | WA
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