Provider Demographics
NPI:1619216462
Name:FIELD, CHERYL PEDERSEN (OT/L)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:PEDERSEN
Last Name:FIELD
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10520 HARBOUR POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-4701
Mailing Address - Country:US
Mailing Address - Phone:425-366-2635
Mailing Address - Fax:
Practice Address - Street 1:10520 HARBOUR POINTE BLVD
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4701
Practice Address - Country:US
Practice Address - Phone:425-366-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001431225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist