Provider Demographics
NPI:1649587973
Name:TARTAGLIA, SHANNON EVETTE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:EVETTE
Last Name:TARTAGLIA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:EVETTE
Other - Last Name:STUTZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:13301 SE 79TH PL UNIT A406
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3236
Mailing Address - Country:US
Mailing Address - Phone:425-687-7691
Mailing Address - Fax:425-793-4594
Practice Address - Street 1:13301 SE 79TH PL UNIT A406
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-3236
Practice Address - Country:US
Practice Address - Phone:425-687-7691
Practice Address - Fax:425-793-4594
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC0001169224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant