Provider Demographics
NPI:1962762302
Name:ZHUKOVSKIY, OLHA V (LMP)
Entity type:Individual
Prefix:MS
First Name:OLHA
Middle Name:V
Last Name:ZHUKOVSKIY
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 1:11825 SE 280TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-8741
Mailing Address - Country:US
Mailing Address - Phone:206-478-2824
Mailing Address - Fax:
Practice Address - Street 1:11825 SE 280TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-8741
Practice Address - Country:US
Practice Address - Phone:206-478-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60283782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist