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NPI Code Detail

MEDICARE: MISS TRICIA SUZANNE WHITE COTA/L

MEDICARE: MISS TRICIA SUZANNE WHITE COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy AssistantOC60210873WA

General Provider Information

NPI Number : 1548514052
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TRICIA SUZANNE WHITE COTA/L
Provider Business Mailing Address
First Line : 4560 SE INTERNATIONAL WAY
Second Line : STE. 100
City : MILWAUKIE
State : OR
Zip : 97222
Country : US
Telephone Number : 971-206-5200
Fax Number : 971-206-5203
Provider Business Practice Location Address
First Line : 6720 E GREEN LAKE WAY N
Second Line :
City : SEATTLE
State : WA
Zip : 98103-5439
Country : US
Telephone Number : 206-525-9666
Fax Number : 971-206-5203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2012
Last Update Date : 11/06/2012

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