Provider Demographics
NPI:1801148333
Name:STURM, MILENA JANKOVICH (MOTR/L)
Entity type:Individual
Prefix:
First Name:MILENA
Middle Name:JANKOVICH
Last Name:STURM
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13384 122ND PL NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5418
Mailing Address - Country:US
Mailing Address - Phone:541-306-0772
Mailing Address - Fax:
Practice Address - Street 1:13384 122ND PL NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5418
Practice Address - Country:US
Practice Address - Phone:541-306-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60274748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist