Provider Demographics
NPI:1003242819
Name:OTT, AYRIAN SHALEE (LMP)
Entity Type:Individual
Prefix:
First Name:AYRIAN
Middle Name:SHALEE
Last Name:OTT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:AYRIAN
Other - Middle Name:SHALEE
Other - Last Name:BETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:7427 NE 144TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4920
Mailing Address - Country:US
Mailing Address - Phone:206-295-3634
Mailing Address - Fax:
Practice Address - Street 1:10024 MAIN ST
Practice Address - Street 2:SUITE 2 C
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3464
Practice Address - Country:US
Practice Address - Phone:425-485-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010715225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist