Provider Demographics
NPI:1174685473
Name:LEA, DESIREE RACHELLE (LMP, MMP)
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:RACHELLE
Last Name:LEA
Suffix:
Gender:F
Credentials:LMP, MMP
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 31183
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3019
Mailing Address - Country:US
Mailing Address - Phone:509-991-6308
Mailing Address - Fax:
Practice Address - Street 1:7527 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-7828
Practice Address - Country:US
Practice Address - Phone:509-991-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013749225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist