Provider Demographics
NPI:1356090583
Name:GAMMELGAARD, TENNILLE ROSE (COTA/L)
Entity Type:Individual
Prefix:
First Name:TENNILLE
Middle Name:ROSE
Last Name:GAMMELGAARD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31811 PACIFIC HWY S
Mailing Address - Street 2:STE B #349
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:206-371-4871
Mailing Address - Fax:
Practice Address - Street 1:915 4TH ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4452
Practice Address - Country:US
Practice Address - Phone:253-931-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60435474224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant