Provider Demographics
NPI:1396069142
Name:COLLYARD, SARAH JANE (NLMP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JANE
Last Name:COLLYARD
Suffix:
Gender:F
Credentials:NLMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 BATES ST SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4055
Mailing Address - Country:US
Mailing Address - Phone:360-956-0599
Mailing Address - Fax:360-705-2708
Practice Address - Street 1:413 BATES ST SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4055
Practice Address - Country:US
Practice Address - Phone:360-956-0599
Practice Address - Fax:360-705-2708
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014122225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist