Provider Demographics
NPI:1003532201
Name:MAISLIN, JOEL ALLAN (LMT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ALLAN
Last Name:MAISLIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 EVERGREEN PARK DR SW APT C16
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5889
Mailing Address - Country:US
Mailing Address - Phone:360-819-0024
Mailing Address - Fax:
Practice Address - Street 1:1818 EVERGREEN PARK DR SW APT C16
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5889
Practice Address - Country:US
Practice Address - Phone:360-819-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61349238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist