Provider Demographics
NPI:1336323690
Name:CEDARCROFT, OSHA GRACE (LMP)
Entity Type:Individual
Prefix:
First Name:OSHA
Middle Name:GRACE
Last Name:CEDARCROFT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:HAMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:4005 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-4705
Mailing Address - Country:US
Mailing Address - Phone:253-230-4957
Mailing Address - Fax:
Practice Address - Street 1:4005 N 19TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-4705
Practice Address - Country:US
Practice Address - Phone:253-230-4957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021278225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist