Provider Demographics
NPI:1225389323
Name:CHARMLEY, DIANE CATHLEEN (RN,LMT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:CATHLEEN
Last Name:CHARMLEY
Suffix:
Gender:F
Credentials:RN,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 NE 72ND AVE
Mailing Address - Street 2:APT 163
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-8111
Mailing Address - Country:US
Mailing Address - Phone:206-963-9594
Mailing Address - Fax:
Practice Address - Street 1:4714 NE 72ND AVE
Practice Address - Street 2:APT 163
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-8111
Practice Address - Country:US
Practice Address - Phone:206-963-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004306225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist