Provider Demographics
NPI:1164777900
Name:SPIKES, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SPIKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:DITTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:19045 HWY 305
Mailing Address - Street 2:SUITE 190
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370
Mailing Address - Country:US
Mailing Address - Phone:360-697-6100
Mailing Address - Fax:360-697-4500
Practice Address - Street 1:19045 HWY 305
Practice Address - Street 2:SUITE 190
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-697-6100
Practice Address - Fax:360-697-4500
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60261272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist