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1790797926

NPI Code Detail

MEDICARE: MARY B SOMMER OTR/L,CHT

MEDICARE: MARY B SOMMER OTR/L,CHT

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
1	225XH1200X	Hand Occupational Therapist	OT00002190	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	670001773	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0291602	OTHER	WA	DEPT. OF LABOR AND INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	156271	OTHER	WA	DEPT OF LABOR & INDUSTRIE
5	3792SO	OTHER	WA	REGENCE BLUE SHIELD
6	A003	OTHER	WA	TRICARE
7	8936362	OTHER	WA	CRIME VICTIMS

General Provider Information

NPI Number	:	1790797926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY B SOMMER OTR/L,CHT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	5605 100TH ST SW
Second Line	:	STE B
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2710
Country	:	US
Telephone Number	:	253-284-9800
Fax Number	:	253-284-9801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/17/2015

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1356362818 — MRS. JILL M PECK LMP
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Practice Fax: 253-284-9801

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1063582211 — MARY Q NELSON
Practice Location Address:

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1942332580 — APPLE PHYSICAL THERAPY LLC
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Directions to “ MARY B SOMMER OTR/L,CHT” Practice Location

Language	Start Address	Practice Location

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