Provider Demographics
NPI:1962246827
Name:DOLLER, REGINA ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ELIZABETH
Last Name:DOLLER
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 1:18142 DIAMOND DR NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8605
Mailing Address - Country:US
Mailing Address - Phone:218-428-9777
Mailing Address - Fax:
Practice Address - Street 1:9621 MICKELBERRY RD NW STE 108
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8301
Practice Address - Country:US
Practice Address - Phone:360-692-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61559051225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist