Provider Demographics
NPI:1083041669
Name:SCHAFFER, TINA (PTA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N TOWNSHIP ST
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1245
Mailing Address - Country:US
Mailing Address - Phone:360-855-3085
Mailing Address - Fax:360-855-3574
Practice Address - Street 1:780 COOK RD
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284
Practice Address - Country:US
Practice Address - Phone:360-855-3889
Practice Address - Fax:360-855-3574
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160378547174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist