Provider Demographics
NPI:1386151462
Name:SEWELL, ALEXIS SEQUOIA MARIE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:SEQUOIA MARIE
Last Name:SEWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:SEQUOIA MARIE
Other - Last Name:SEWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:208 N ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3323
Mailing Address - Country:US
Mailing Address - Phone:425-923-9469
Mailing Address - Fax:
Practice Address - Street 1:208 N ANDERSON ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3323
Practice Address - Country:US
Practice Address - Phone:425-923-9469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60815417225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist