Provider Demographics
NPI:1962633099
Name:MUSIC, WENDY CASSIOPEIA (LMP, LAMP)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:CASSIOPEIA
Last Name:MUSIC
Suffix:
Gender:F
Credentials:LMP, LAMP
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 1481
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-0968
Mailing Address - Country:US
Mailing Address - Phone:360-868-7047
Mailing Address - Fax:
Practice Address - Street 1:1017 4TH AVE E
Practice Address - Street 2:SUITE 5
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4016
Practice Address - Country:US
Practice Address - Phone:360-868-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60055419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist