Provider Demographics
NPI:1104167485
Name:SUMMERS, TRICIA (OTR/L)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:HARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1318 W IVY AVE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 W IVY AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2047
Practice Address - Country:US
Practice Address - Phone:509-766-2670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004491225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist