Provider Demographics
NPI:1356881197
Name:TERRY, RUTH ELAINE (COTA)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ELAINE
Last Name:TERRY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ELAIN
Other - Last Name:TERRY-PANTENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E BLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 E BLAIR AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3525
Practice Address - Country:US
Practice Address - Phone:425-301-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 60308732224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant