Provider Demographics
NPI:1922799758
Name:SAKURA LIFE THERAPY, PLLC
Entity Type:Organization
Organization Name:SAKURA LIFE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AI
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:425-931-6098
Mailing Address - Street 1:3717 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7985
Mailing Address - Country:US
Mailing Address - Phone:425-931-6098
Mailing Address - Fax:
Practice Address - Street 1:3717 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7985
Practice Address - Country:US
Practice Address - Phone:425-931-6098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service