Basic Information
| Provider Information | |||||||||
| NPI: | 1336228261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SISCO | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | OTR-L | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HANNA | ||||||||
| OtherFirstName: | KATE | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 368 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985070368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604133842 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3901 CAPITAL MALL DR SW | ||||||||
| Address2: | SUITE D | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985028654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607096221 | ||||||||
| FaxNumber: | 3603594727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 11/08/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | OT00003444 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225X00000X | OT00003444 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 4169HA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 710883456-98502-A003 | 01 | WA | TRICARE | OTHER | 6840KI | 01 | WA | REGENCE | OTHER | 710883456-98503-A006 | 01 | WA | TRICARE | OTHER | 6910HA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8943009 | 01 | WA | L&I CRIME VICTIMS | OTHER | 0214998 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 2179HA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8341331 | 05 | WA | MEDICAID | 8430KI | 01 | WA | REGENCE | OTHER | 710883456-98512-A004 | 01 | WA | TRICARE | OTHER | 7328573 | 01 | WA | AETNA | OTHER | P00639804 | 01 | WA | RAILROAD MEDICARE | OTHER |