Provider Demographics
NPI:1184655490
Name:SIEMER, MARGARET GRACE (OTR/L; CLT)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:GRACE
Last Name:SIEMER
Suffix:
Gender:F
Credentials:OTR/L; CLT
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:GRACE
Other - Last Name:SHANNON JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L; CLT
Mailing Address - Street 1:10505 19TH AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4280
Mailing Address - Country:US
Mailing Address - Phone:408-570-0510
Mailing Address - Fax:408-570-4018
Practice Address - Street 1:9514 4TH ST NE
Practice Address - Street 2:101
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1937
Practice Address - Country:US
Practice Address - Phone:425-397-2327
Practice Address - Fax:425-377-0283
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6976225XH1200X
WAOT00004496225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOT00004496OtherWA LICENSE
CAOT0069760OtherBLUE SHIELD
CAOT0069760OtherBLUE SHIELD
WA6346850001Medicare NSC
WAOT00004496OtherWA LICENSE