Provider Demographics
NPI:1942214804
Name:THERAPEUTIC ASSOCIATES INC
Entity Type:Organization
Organization Name:THERAPEUTIC ASSOCIATES INC
Other - Org Name:TAI WANDERMERE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR PAYER & PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-443-6156
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:503-443-6156
Mailing Address - Fax:503-443-1402
Practice Address - Street 1:101 E HASTINGS RD
Practice Address - Street 2:STE J
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-4901
Practice Address - Country:US
Practice Address - Phone:509-926-5367
Practice Address - Fax:509-466-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB11525Medicare PIN