Provider Demographics
NPI:1164624607
Name:WOCHADLO, DONNA LOUISE (LMP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LOUISE
Last Name:WOCHADLO
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:PO BOX 3595
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-3595
Mailing Address - Country:US
Mailing Address - Phone:928-234-4400
Mailing Address - Fax:
Practice Address - Street 1:25 SOUTH ASH ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-0000
Practice Address - Country:US
Practice Address - Phone:928-234-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017589225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist