Provider Demographics
NPI:1083033021
Name:HERMIZ, JAMES T (OT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:HERMIZ
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2143
Mailing Address - Country:US
Mailing Address - Phone:206-302-1200
Mailing Address - Fax:877-516-8135
Practice Address - Street 1:601 BROADWAY STE 600
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5330
Practice Address - Country:US
Practice Address - Phone:206-386-6171
Practice Address - Fax:206-860-6694
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61084126225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2168375Medicaid