Provider Demographics
NPI:1952181398
Name:SIBBLIES, SAMARA M (OTD , OTR/L)
Entity type:Individual
Prefix:
First Name:SAMARA
Middle Name:M
Last Name:SIBBLIES
Suffix:
Gender:F
Credentials:OTD , OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 OCCIDENTAL AVE S UNIT 1012
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-6822
Mailing Address - Country:US
Mailing Address - Phone:253-365-8460
Mailing Address - Fax:
Practice Address - Street 1:805 4TH AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4089
Practice Address - Country:US
Practice Address - Phone:206-284-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61482657225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist