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Individual

MRS. TAMI LEANNE BROCKSCHMIDT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
22409 100TH AVE SE, KENT, WA 98031-4228
(253) 856-8053
Mailing address
22409 100TH AVE SE, KENT, WA 98031-4228
(253) 856-8053

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT 00002772
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
174400000X
WA
Enumeration date
09/28/2012
Last updated
09/28/2012
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