Provider Demographics
NPI:1790797926
Name:SOMMER, MARY B (OTR/L,CHT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:SOMMER
Suffix:
Gender:F
Credentials:OTR/L,CHT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:B
Other - Last Name:BOUGHFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L,CHT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:5605 100TH ST SW
Practice Address - Street 2:STE B
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2710
Practice Address - Country:US
Practice Address - Phone:253-284-9800
Practice Address - Fax:253-284-9801
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002190225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0291602OtherDEPT. OF LABOR AND INDUSTRIES
WA8330532Medicaid
WA670001773OtherRAILROAD MEDICARE
WA156271OtherDEPT OF LABOR & INDUSTRIE
WA3792SOOtherREGENCE BLUE SHIELD
WAA003OtherTRICARE
WA8936362OtherCRIME VICTIMS
WA670001773OtherRAILROAD MEDICARE
WA8936362OtherCRIME VICTIMS