Provider Demographics
NPI:1194021188
Name:DECKER, ANGELA KAY (LMT,MMP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:DECKER
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N STATE ST STE 305
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5024
Mailing Address - Country:US
Mailing Address - Phone:360-483-7559
Mailing Address - Fax:872-111-6228
Practice Address - Street 1:1155 N STATE ST STE 305
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5024
Practice Address - Country:US
Practice Address - Phone:360-483-7559
Practice Address - Fax:872-111-6228
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60362424225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist