Provider Demographics
NPI:1316338973
Name:KREBSBACH, ASHLEY CHARMAYNE (MASSAGE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CHARMAYNE
Last Name:KREBSBACH
Suffix:
Gender:F
Credentials:MASSAGE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 VINING ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5625
Mailing Address - Country:US
Mailing Address - Phone:360-319-1029
Mailing Address - Fax:
Practice Address - Street 1:3710 VINING ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5625
Practice Address - Country:US
Practice Address - Phone:360-319-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60395261172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker