Provider Demographics
NPI:1952537102
Name:FISKE, ANDREA MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:FISKE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:400 S 43RD ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5714
Mailing Address - Country:US
Mailing Address - Phone:425-656-5516
Mailing Address - Fax:425-656-4028
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-656-5516
Practice Address - Fax:425-656-4028
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOXC00001261224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant