Provider Demographics
NPI:1780614586
Name:SANCILIO, TINA MIKA (OTR/L)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MIKA
Last Name:SANCILIO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 SW TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3744
Mailing Address - Country:US
Mailing Address - Phone:206-769-4366
Mailing Address - Fax:
Practice Address - Street 1:VA PUGET SOUND HEALTH CARE SYSTEM - SEATTLE
Practice Address - Street 2:1660 S. COLUMBIAN WAY
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108
Practice Address - Country:US
Practice Address - Phone:206-277-6093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003289225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist