Provider Demographics
NPI:1528302627
Name:GANSKE GUILLIAUME, SABRINA (OTR/L)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:GANSKE GUILLIAUME
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7126 285TH ST NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8406
Mailing Address - Country:US
Mailing Address - Phone:360-654-4325
Mailing Address - Fax:
Practice Address - Street 1:1216 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1119
Practice Address - Country:US
Practice Address - Phone:360-618-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003374225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics