Provider Demographics
NPI:1356689178
Name:SMITHERS, BRENDA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:SMITHERS
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 1:17077 MERIDIAN AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5531
Mailing Address - Country:US
Mailing Address - Phone:206-393-1700
Mailing Address - Fax:
Practice Address - Street 1:17077 MERIDIAN AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5531
Practice Address - Country:US
Practice Address - Phone:206-393-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 00000186224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant