Provider Demographics
NPI:1497168769
Name:NATIVIDAD, SILVERIO
Entity Type:Individual
Prefix:MR
First Name:SILVERIO
Middle Name:
Last Name:NATIVIDAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21620 14TH AVE S APT I102
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-8351
Mailing Address - Country:US
Mailing Address - Phone:206-384-3399
Mailing Address - Fax:
Practice Address - Street 1:2830 I ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-2410
Practice Address - Country:US
Practice Address - Phone:253-561-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60468830224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant