Provider Demographics
NPI:1962803411
Name:WOODIN, AMANDA (LMP)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:WOODIN
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 1:162 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2406
Mailing Address - Country:US
Mailing Address - Phone:509-684-1420
Mailing Address - Fax:509-684-6293
Practice Address - Street 1:162 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2406
Practice Address - Country:US
Practice Address - Phone:509-684-1420
Practice Address - Fax:509-684-6293
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60471245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist