Individual
JESSICA SIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
400 29TH ST NE, PUYALLUP, WA 98372-6774
(903) 267-9981
Mailing address
9822 158TH ST E APT 1, PUYALLUP, WA 98375-8919
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OC60610891
WA
Other
Enumeration date
12/28/2020
Last updated
12/28/2020
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