Provider Demographics
NPI:1104898683
Name:HARRISON-WEAVER, SANDRA (MHE, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HARRISON-WEAVER
Suffix:
Gender:F
Credentials:MHE, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 181ST ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER
Practice Address - Street 2:9040A FITZSIMMONS DRIVE MCHJ-PMO
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-5000
Practice Address - Country:US
Practice Address - Phone:253-968-2330
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist