Provider Demographics
NPI:1568420867
Name:SUGITA, FERN M O (BS OTRL)
Entity type:Individual
Prefix:
First Name:FERN
Middle Name:M O
Last Name:SUGITA
Suffix:
Gender:F
Credentials:BS OTRL
Other - Prefix:
Other - First Name:FERN
Other - Middle Name:M O
Other - Last Name:OKAHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:7308 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8000
Practice Address - Country:US
Practice Address - Phone:253-582-8500
Practice Address - Fax:253-582-8506
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001268225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8413379Medicaid
WA88050415Medicare ID - Type Unspecified
WA8413379Medicaid