Provider Demographics
NPI:1457744732
Name:WORKIE, TEZETA H (COTA)
Entity Type:Individual
Prefix:
First Name:TEZETA
Middle Name:H
Last Name:WORKIE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TEZETA
Other - Middle Name:H
Other - Last Name:WORKIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:748 N 101ST ST
Mailing Address - Street 2:N/A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9312
Mailing Address - Country:US
Mailing Address - Phone:206-353-6490
Mailing Address - Fax:
Practice Address - Street 1:25117 SW PARKWAY AVE STE D
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9697
Practice Address - Country:US
Practice Address - Phone:971-224-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60526311224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant