Provider Demographics
NPI:1992933501
Name:ALLEN, SIENE NICOLE (LMT)
Entity type:Individual
Prefix:
First Name:SIENE
Middle Name:NICOLE
Last Name:ALLEN
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:PO BOX 3254
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-3254
Mailing Address - Country:US
Mailing Address - Phone:406-210-3245
Mailing Address - Fax:
Practice Address - Street 1:326 CENTER AVE STE 201
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7303
Practice Address - Country:US
Practice Address - Phone:406-210-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 56321225700000X
MT746225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist