Provider Demographics
NPI:1083196091
Name:DEETER, AMBER (LMP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DEETER
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 1:3908 CREEKSIDE LOOP STE 110
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4858
Mailing Address - Country:US
Mailing Address - Phone:509-571-1084
Mailing Address - Fax:509-248-5356
Practice Address - Street 1:3908 CREEKSIDE LOOP STE 110
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4858
Practice Address - Country:US
Practice Address - Phone:509-571-1081
Practice Address - Fax:509-248-5356
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60888925225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60888925OtherMASSAGE THERAPIST