Provider Demographics
NPI:1194040618
Name:STUDER, DIANA CASSANDRA (LMT, LMP, CEIM)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:CASSANDRA
Last Name:STUDER
Suffix:
Gender:F
Credentials:LMT, LMP, CEIM
Other - Prefix:MRS
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:STUDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, LMP, CEIM
Mailing Address - Street 1:1709 GILES AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4733
Mailing Address - Country:US
Mailing Address - Phone:360-561-2587
Mailing Address - Fax:
Practice Address - Street 1:1709 GILES AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4733
Practice Address - Country:US
Practice Address - Phone:360-561-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025186225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00025186OtherWA STATE MASSAGE BOARD