Provider Demographics
NPI:1255786307
Name:PENINSULA STRUCTURAL MEDICINE
Entity type:Organization
Organization Name:PENINSULA STRUCTURAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:253-677-8179
Mailing Address - Street 1:4102 52ND AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7666
Mailing Address - Country:US
Mailing Address - Phone:253-677-8179
Mailing Address - Fax:253-697-0213
Practice Address - Street 1:4102 52ND AVENUE CT NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-7666
Practice Address - Country:US
Practice Address - Phone:253-677-8179
Practice Address - Fax:253-697-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty