Provider Demographics
NPI:1740824994
Name:CHMIELEWSKI, TRACY LEEANNE (OT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEEANNE
Last Name:CHMIELEWSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20612 SE 294TH WAY
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-6849
Mailing Address - Country:US
Mailing Address - Phone:206-915-0494
Mailing Address - Fax:
Practice Address - Street 1:31135 228TH AVE SE
Practice Address - Street 2:
Practice Address - City:BLACK DIAMOND
Practice Address - State:WA
Practice Address - Zip Code:98010-1708
Practice Address - Country:US
Practice Address - Phone:253-373-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60064456225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist