Provider Demographics
NPI:1427247857
Name:TAISEY, BERNADETTE M (LMP)
Entity type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:M
Last Name:TAISEY
Suffix:
Gender:F
Credentials:LMP
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 66174
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-0174
Mailing Address - Country:US
Mailing Address - Phone:206-246-8355
Mailing Address - Fax:206-244-7799
Practice Address - Street 1:635 S.W. 154TH STREET
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-0174
Practice Address - Country:US
Practice Address - Phone:206-246-8355
Practice Address - Fax:206-244-7799
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004112225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA31194OtherLABOR & INDUSTRIES