Provider Demographics
NPI:1972021830
Name:SCHUBERT, VANESSA GAY DOWNER (COTA/L)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:GAY DOWNER
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 E WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3134
Mailing Address - Country:US
Mailing Address - Phone:206-579-3064
Mailing Address - Fax:
Practice Address - Street 1:350 W FIR ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3352
Practice Address - Country:US
Practice Address - Phone:360-582-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60792444224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant