Provider Demographics
NPI:1033128236
Name:GUARDIA, MARY CHARLENE (OTR/L,CHT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHARLENE
Last Name:GUARDIA
Suffix:
Gender:F
Credentials:OTR/L,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 32ND AVE NW
Mailing Address - Street 2:STE 104
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6308
Mailing Address - Country:US
Mailing Address - Phone:253-363-3758
Mailing Address - Fax:
Practice Address - Street 1:2921 78TH AVENUE CT NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6498
Practice Address - Country:US
Practice Address - Phone:253-363-3758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002991225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand