Provider Demographics
NPI:1801835681
Name:MERTENS, TERENCE P (OTR/L)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:P
Last Name:MERTENS
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 1:2120 MOTTMAN ROAD S.W.
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512
Mailing Address - Country:US
Mailing Address - Phone:360-357-7466
Mailing Address - Fax:360-357-1151
Practice Address - Street 1:2120 MOTTMAN ROAD S.W.
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512
Practice Address - Country:US
Practice Address - Phone:360-357-7466
Practice Address - Fax:360-357-1151
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002928225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0213573OtherLABOR AND INDUSTRIES
WAME5173OtherREGENCE BLUESHIELD