Provider Demographics
NPI:1396863668
Name:OSTERTAG, PATRICIA (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:OSTERTAG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16120 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-3937
Mailing Address - Country:US
Mailing Address - Phone:425-985-8932
Mailing Address - Fax:
Practice Address - Street 1:9722 218TH PL NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-7624
Practice Address - Country:US
Practice Address - Phone:425-985-8932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007751174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7018120Medicaid