Provider Demographics
NPI:1164687505
Name:SIEMS, HEATHER IRENE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:IRENE
Last Name:SIEMS
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 1:5530 55TH LOOP SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-4631
Mailing Address - Country:US
Mailing Address - Phone:360-280-5976
Mailing Address - Fax:360-866-1461
Practice Address - Street 1:5530 55TH LOOP SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-4631
Practice Address - Country:US
Practice Address - Phone:360-280-5976
Practice Address - Fax:360-866-1461
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00019274225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist