Provider Demographics
NPI:1336228261
Name:SISCO, KATE E (OTR-L)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:E
Last Name:SISCO
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:ELIZABETH
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-0368
Mailing Address - Country:US
Mailing Address - Phone:360-413-3842
Mailing Address - Fax:
Practice Address - Street 1:3901 CAPITAL MALL DR SW
Practice Address - Street 2:SUITE D
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8654
Practice Address - Country:US
Practice Address - Phone:360-709-6221
Practice Address - Fax:360-359-4727
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003444225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4169HAOtherREGENCE BLUE SHIELD
WA710883456-98502-A003OtherTRICARE
WA6840KIOtherREGENCE
WA710883456-98503-A006OtherTRICARE
WA6910HAOtherREGENCE BLUE SHIELD
WA8943009OtherL&I CRIME VICTIMS
WA0214998OtherDEPT. OF LABOR & INDUSTRY
WA2179HAOtherREGENCE BLUE SHIELD
WA8341331Medicaid
WA8430KIOtherREGENCE
WA710883456-98512-A004OtherTRICARE
WA7328573OtherAETNA
WAP00639804OtherRAILROAD MEDICARE
WA2179HAOtherREGENCE BLUE SHIELD