Provider Demographics
NPI:1306093299
Name:SAUCEDO, DAHLI A (LMP)
Entity type:Individual
Prefix:
First Name:DAHLI
Middle Name:A
Last Name:SAUCEDO
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 1:3350 ROAD 12 SW
Mailing Address - Street 2:
Mailing Address - City:ROYAL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99357-9713
Mailing Address - Country:US
Mailing Address - Phone:509-989-7801
Mailing Address - Fax:
Practice Address - Street 1:361 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1055
Practice Address - Country:US
Practice Address - Phone:509-488-3346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60018962225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist