Provider Demographics
NPI:1235416504
Name:DERHEIM, CHERISE EILEEN (LMP)
Entity Type:Individual
Prefix:
First Name:CHERISE
Middle Name:EILEEN
Last Name:DERHEIM
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 1:811 PIERCE LN NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1737
Mailing Address - Country:US
Mailing Address - Phone:253-632-6285
Mailing Address - Fax:
Practice Address - Street 1:811 PIERCE LN NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1737
Practice Address - Country:US
Practice Address - Phone:253-632-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017803225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist