Provider Demographics
NPI:1114123379
Name:ADAMS, REBECCA MICHELLE (LMP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MICHELLE
Last Name:ADAMS
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 1:914 D ST NE
Mailing Address - Street 2:STE. 101
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4163
Mailing Address - Country:US
Mailing Address - Phone:253-939-0960
Mailing Address - Fax:253-939-3381
Practice Address - Street 1:914 D ST NE
Practice Address - Street 2:STE. 101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4163
Practice Address - Country:US
Practice Address - Phone:253-939-0960
Practice Address - Fax:253-939-3381
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00022426225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADEPT. OF L & IOther0217243