Provider Demographics
NPI:1033470182
Name:CHRISTIANSEN, DELTA ELIZABETH O'DELL (LMP)
Entity Type:Individual
Prefix:
First Name:DELTA
Middle Name:ELIZABETH O'DELL
Last Name:CHRISTIANSEN
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 1:6822 HUSKY WAY SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1438
Mailing Address - Country:US
Mailing Address - Phone:360-259-2072
Mailing Address - Fax:
Practice Address - Street 1:6822 HUSKY WAY SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1438
Practice Address - Country:US
Practice Address - Phone:360-259-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60293779225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist