Provider Demographics
NPI:1104150218
Name:BASSETT, ALLISON L (LMP)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:L
Last Name:BASSETT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:OTIS/PRITCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23448 SHERRY LANE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-9114
Mailing Address - Country:US
Mailing Address - Phone:360-333-3565
Mailing Address - Fax:
Practice Address - Street 1:23448 SHERRY LANE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-9114
Practice Address - Country:US
Practice Address - Phone:360-333-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist