Provider Demographics
NPI:1356473417
Name:ROLLESON HAMEL, CONSTANCE MARIE (MASSAGE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:MARIE
Last Name:ROLLESON HAMEL
Suffix:
Gender:F
Credentials:MASSAGE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32305 MILL CANYON RD N
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122
Mailing Address - Country:US
Mailing Address - Phone:509-725-0676
Mailing Address - Fax:
Practice Address - Street 1:327 W 8TH
Practice Address - Street 2:SUITE 222
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204
Practice Address - Country:US
Practice Address - Phone:509-624-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004199225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0034632OtherL AND I