Provider Demographics
NPI:1942363486
Name:CLERC, TIERZA RENE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:TIERZA
Middle Name:RENE
Last Name:CLERC
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 SW BARTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3810
Mailing Address - Country:US
Mailing Address - Phone:253-223-1751
Mailing Address - Fax:
Practice Address - Street 1:3220 SW BARTON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3810
Practice Address - Country:US
Practice Address - Phone:253-223-1751
Practice Address - Fax:253-223-1751
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013224225700000X
WA61394253225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0175380OtherL&I STATE NUMBER