Provider Demographics
NPI:1073791901
Name:REASE, BILLIE JO (LMP)
Entity Type:Individual
Prefix:MS
First Name:BILLIE
Middle Name:JO
Last Name:REASE
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 1:210 N PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-3414
Mailing Address - Country:US
Mailing Address - Phone:360-442-6317
Mailing Address - Fax:
Practice Address - Street 1:3827 MINT PL
Practice Address - Street 2:APT. A-16
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4976
Practice Address - Country:US
Practice Address - Phone:360-442-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024307225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist