Provider Demographics
NPI:1124356217
Name:BUSHMAKER, ANGELA CHRISTINE (LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:BUSHMAKER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14107 STATE ROUTE 165 E
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-9387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:360-829-2525
Practice Address - Street 1:14107 STATE ROUTE 165 E
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-9387
Practice Address - Country:US
Practice Address - Phone:360-829-2525
Practice Address - Fax:360-829-2525
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1 600351652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer