Provider Demographics
NPI:1790210854
Name:CISNEROS, ELIZABETH PACKARD (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PACKARD
Last Name:CISNEROS
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 1:9444 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2811
Mailing Address - Country:US
Mailing Address - Phone:925-286-1341
Mailing Address - Fax:
Practice Address - Street 1:1601 E YESLER WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5640
Practice Address - Country:US
Practice Address - Phone:206-313-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60729894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist