Provider Demographics
NPI:1346770302
Name:POOLE, FELICIA (LMT)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:BINGEN
Mailing Address - State:WA
Mailing Address - Zip Code:98605-0717
Mailing Address - Country:US
Mailing Address - Phone:541-490-7693
Mailing Address - Fax:
Practice Address - Street 1:288 E JEWETT BLVD STE 900
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-3000
Practice Address - Country:US
Practice Address - Phone:541-490-7693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60872392225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA-60872392OtherLICENSED MASSAGE THERAPIST