Provider Demographics
NPI:1770691586
Name:ARCHER, TERESA LOUISE (OTA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LOUISE
Last Name:ARCHER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8713 NEWGROVE AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-2549
Mailing Address - Country:US
Mailing Address - Phone:253-584-5027
Mailing Address - Fax:253-537-3150
Practice Address - Street 1:1830 112TH ST E
Practice Address - Street 2:SUITE D
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-3747
Practice Address - Country:US
Practice Address - Phone:253-548-8400
Practice Address - Fax:253-537-3150
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00000168224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant