Provider Demographics
NPI:1033402490
Name:CABELLON, AMANDA VICTORIA (LMP)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:VICTORIA
Last Name:CABELLON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32633 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-5479
Mailing Address - Country:US
Mailing Address - Phone:253-332-8212
Mailing Address - Fax:
Practice Address - Street 1:202 S 348TH ST
Practice Address - Street 2:STE. #4
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7070
Practice Address - Country:US
Practice Address - Phone:253-874-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60215451225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist