Provider Demographics
NPI:1154497907
Name:HEIAN, HOLLY NOELLE (LMP)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:NOELLE
Last Name:HEIAN
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 1:6334 LITTLEROCK RD SW
Mailing Address - Street 2:BLDG 6, SUITE 101
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512
Mailing Address - Country:US
Mailing Address - Phone:360-359-2162
Mailing Address - Fax:360-709-9220
Practice Address - Street 1:6334 LITTLEROCK RD SW
Practice Address - Street 2:BLDG 6, SUITE 101
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512
Practice Address - Country:US
Practice Address - Phone:360-359-2162
Practice Address - Fax:360-709-9220
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA17411225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA17411OtherHEALTH LICENSE