Provider Demographics
NPI:1003241746
Name:SANDERS, TRUDY H (LMP)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:H
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:GERTRUDE
Other - Middle Name:H
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-0091
Mailing Address - Country:US
Mailing Address - Phone:360-240-8624
Mailing Address - Fax:
Practice Address - Street 1:1091 SE DOCK ST
Practice Address - Street 2:UNIT 1
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-4065
Practice Address - Country:US
Practice Address - Phone:360-240-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00011735225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist