Provider Demographics
NPI:1346405818
Name:FEIN, RISA M (L M P)
Entity Type:Individual
Prefix:
First Name:RISA
Middle Name:M
Last Name:FEIN
Suffix:
Gender:F
Credentials:L M P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14636 NE 45TH ST
Mailing Address - Street 2:# C 6
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3134
Mailing Address - Country:US
Mailing Address - Phone:425-442-5624
Mailing Address - Fax:
Practice Address - Street 1:2110 116TH AVE NE
Practice Address - Street 2:SUITE C
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3040
Practice Address - Country:US
Practice Address - Phone:425-453-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00021490225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist