Provider Demographics
NPI:1386356830
Name:REESE, LAURA MARIE (LMT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARIE
Last Name:REESE
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 1:107 SE WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2328
Mailing Address - Country:US
Mailing Address - Phone:503-453-7063
Mailing Address - Fax:
Practice Address - Street 1:221A NE 104TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-4539
Practice Address - Country:US
Practice Address - Phone:360-737-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61382091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist