Provider Demographics
NPI:1114143401
Name:WHILEY, SANDRA JASMINE (LMP, CLT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JASMINE
Last Name:WHILEY
Suffix:
Gender:F
Credentials:LMP, CLT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JASMINE
Other - Last Name:WHILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP, CLT
Mailing Address - Street 1:16520 N PARK AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5323
Mailing Address - Country:US
Mailing Address - Phone:206-280-1851
Mailing Address - Fax:
Practice Address - Street 1:522 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3079
Practice Address - Country:US
Practice Address - Phone:360-990-9511
Practice Address - Fax:360-208-0604
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602106531OtherUBI NUMBER
WA$$$$$$$$$OtherMEDICAL MASSAGE PRACTITIONER
WA602106531OtherUBI NUMBER