Provider Demographics
NPI:1639941230
Name:CLIFFORD, PETER (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-8204
Mailing Address - Country:US
Mailing Address - Phone:360-461-0889
Mailing Address - Fax:
Practice Address - Street 1:64 WILDWOOD LN
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-8204
Practice Address - Country:US
Practice Address - Phone:360-461-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001088225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty