Provider Demographics
NPI:1215144852
Name:WOLF-DAIS, MISTY M (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:M
Last Name:WOLF-DAIS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7648 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-5311
Mailing Address - Country:US
Mailing Address - Phone:253-414-4879
Mailing Address - Fax:
Practice Address - Street 1:1510 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1929
Practice Address - Country:US
Practice Address - Phone:253-759-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist