Provider Demographics
NPI:1336470020
Name:WAATTI, SHARON LEE (LMP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LEE
Last Name:WAATTI
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 1:128 4TH AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-8459
Mailing Address - Country:US
Mailing Address - Phone:425-778-0400
Mailing Address - Fax:425-778-0401
Practice Address - Street 1:128 4TH AVE S STE 102
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-8459
Practice Address - Country:US
Practice Address - Phone:425-778-0400
Practice Address - Fax:425-778-0401
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00010205225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist