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General NPI Number Information
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NPI Number | 1902489644
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Entity Type | Individual
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Provider Name | AUSTIN DANCER OTR
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Gender | Male
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 242 ST HELENS AVE
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City | TACOMA
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State | WA
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Zip | 98402-2514
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Country | US
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Telephone | 253-627-3833
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Fax |
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Provider Business Mailing Address
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Address Line | 4720 S PINE ST
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City | TACOMA
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State | WA
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Zip | 98409-6404
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Country | US
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Telephone | 623-208-8970
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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 |
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License Number State |
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