Provider Demographics
NPI:1083758494
Name:FAIR-FIELD, TERESA (OT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:FAIR-FIELD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16150 NE 85TH ST
Mailing Address - Street 2:STE. #220
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3539
Mailing Address - Country:US
Mailing Address - Phone:425-558-0558
Mailing Address - Fax:425-526-5535
Practice Address - Street 1:16150 NE 85TH ST
Practice Address - Street 2:STE. #220
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3539
Practice Address - Country:US
Practice Address - Phone:425-558-0558
Practice Address - Fax:425-526-5535
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002166225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS2308961OtherAETNA SPECIALIST PIN
WA0039584OtherLABOR AND INDUSTRIES #
WA8394595Medicaid
WAFA2971OtherBLUE SHIELD #
WA0039584OtherLABOR AND INDUSTRIES #
WA8394595Medicaid