Provider Demographics
NPI:1679861504
Name:SAMPLES, BRENDA HELEN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:HELEN
Last Name:SAMPLES
Suffix:
Gender:F
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 1:970 5TH AVE NW
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2469
Mailing Address - Country:US
Mailing Address - Phone:253-230-5641
Mailing Address - Fax:253-912-4774
Practice Address - Street 1:1355 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2022
Practice Address - Country:US
Practice Address - Phone:360-794-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00000193174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist