Provider Demographics
NPI:1164913422
Name:SAUTER, EZRA JAMES (OTR)
Entity Type:Individual
Prefix:MR
First Name:EZRA
Middle Name:JAMES
Last Name:SAUTER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 S HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2090
Mailing Address - Country:US
Mailing Address - Phone:612-747-9937
Mailing Address - Fax:
Practice Address - Street 1:319 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5767
Practice Address - Country:US
Practice Address - Phone:253-850-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60704653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist