Provider Demographics
NPI:1386710358
Name:INTEGRATIVE OT, PLLC
Entity type:Organization
Organization Name:INTEGRATIVE OT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:STAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:206-368-7897
Mailing Address - Street 1:PO BOX 75162
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98175-0162
Mailing Address - Country:US
Mailing Address - Phone:206-368-7897
Mailing Address - Fax:
Practice Address - Street 1:11520 25TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5218
Practice Address - Country:US
Practice Address - Phone:206-368-7897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000806261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherEIN