Provider Demographics
NPI:1013909720
Name:TETER, SANDRA E (OT, CHT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:E
Last Name:TETER
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:E
Other - Last Name:CHOMIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT, CHT
Mailing Address - Street 1:4220 132ND ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:9411 192ND AVE E BLDG D
Practice Address - Street 2:SUITE E
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8564
Practice Address - Country:US
Practice Address - Phone:253-268-5105
Practice Address - Fax:253-258-3298
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001042225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA185877OtherL&I
WA8376683Medicaid
WAP00403555OtherMEDICARE RAILROAD
WA6162TEOtherREGENCE BS
WA8938039OtherCRIME VICTIMS
WA185877OtherL&I
WAG8803119Medicare PIN