Provider Demographics
NPI:1104961374
Name:ABBOTT, ANDREA MARIE (LMP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARIE
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12628 NE 85TH ST
Mailing Address - Street 2:LAKEVIEW CHIROPRACTIC AND MASSAGE
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:425-827-0334
Mailing Address - Fax:425-827-3572
Practice Address - Street 1:12628 NE 85TH ST
Practice Address - Street 2:LAKEVIEW CHIROPRACTIC AND MASSAGE
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033
Practice Address - Country:US
Practice Address - Phone:425-827-0334
Practice Address - Fax:425-827-3572
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009785225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0150345OtherL & I