Provider Demographics
NPI:1346302015
Name:AVELLE, ERIN M (LMP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:AVELLE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:A
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:32533 107TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-4726
Mailing Address - Country:US
Mailing Address - Phone:253-833-6722
Mailing Address - Fax:
Practice Address - Street 1:914 D ST NE
Practice Address - Street 2:SUITE 101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4163
Practice Address - Country:US
Practice Address - Phone:253-939-0906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020482225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist