Provider Demographics
NPI:1336287192
Name:TWYMAN, JAMIE JODELL (LMP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:JODELL
Last Name:TWYMAN
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 1:26903 NE 44TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7183
Mailing Address - Country:US
Mailing Address - Phone:360-834-3095
Mailing Address - Fax:
Practice Address - Street 1:417 NE BIRCH ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2139
Practice Address - Country:US
Practice Address - Phone:360-834-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021568225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist