Provider Demographics
NPI:1225273295
Name:O'ROURKE, TANA (OTR)
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:TANA
Other - Middle Name:
Other - Last Name:BOATRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1315 HANSBERRY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-7447
Mailing Address - Country:US
Mailing Address - Phone:360-688-0092
Mailing Address - Fax:
Practice Address - Street 1:1315 HANSBERRY AVE NE
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-7447
Practice Address - Country:US
Practice Address - Phone:360-688-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-4605225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics