Provider Demographics
NPI:1639518400
Name:AMANDA SALIBA PEDIATRIC OCCUPATIONAL THERAPY SERVICES
Entity Type:Organization
Organization Name:AMANDA SALIBA PEDIATRIC OCCUPATIONAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALIBA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:253-447-8562
Mailing Address - Street 1:PO BOX 8352
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-0101
Mailing Address - Country:US
Mailing Address - Phone:253-447-8562
Mailing Address - Fax:253-987-5308
Practice Address - Street 1:20069 SR 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8460
Practice Address - Country:US
Practice Address - Phone:253-447-8562
Practice Address - Fax:253-987-5308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty