Provider Demographics
NPI:1093961153
Name:HAMILTON, DIANE MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:HAMILTON
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 1:1811 QUEEN ANNE AVE N
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2850
Mailing Address - Country:US
Mailing Address - Phone:206-387-6535
Mailing Address - Fax:
Practice Address - Street 1:1811 QUEEN ANNE AVE N
Practice Address - Street 2:SUITE # 204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2850
Practice Address - Country:US
Practice Address - Phone:206-387-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008703225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist