Provider Demographics
NPI:1043653959
Name:TRETTENERO, MARYANNE CHURCH (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:CHURCH
Last Name:TRETTENERO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S 336TH ST
Mailing Address - Street 2:210
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:866-835-8091
Mailing Address - Fax:888-835-7102
Practice Address - Street 1:1010 S 336TH ST
Practice Address - Street 2:210
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:866-835-8091
Practice Address - Fax:888-835-7102
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003619225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation