Provider Demographics
NPI:1003316688
Name:BOLANDER, JAYMIE NOELLE (LMT)
Entity Type:Individual
Prefix:
First Name:JAYMIE
Middle Name:NOELLE
Last Name:BOLANDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JAYMIE
Other - Middle Name:NOELLE
Other - Last Name:POAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2500 NW CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-3932
Mailing Address - Country:US
Mailing Address - Phone:509-885-8328
Mailing Address - Fax:
Practice Address - Street 1:1120 GRANT RD
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5243
Practice Address - Country:US
Practice Address - Phone:509-884-7163
Practice Address - Fax:509-884-2363
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60823097225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60823097OtherMASSAGE