Provider Demographics
NPI:1477678118
Name:SUAREZ-LUDWIG, SANDRA (OT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SUAREZ-LUDWIG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:SUAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:STE. 290
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:1804 W UNION AVE
Practice Address - Street 2:STE. 101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2062
Practice Address - Country:US
Practice Address - Phone:253-759-4036
Practice Address - Fax:253-759-4341
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO003641225X00000X
WAOT60468226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8931004Medicare PIN
WAG8931005Medicare PIN