Provider Demographics
NPI:1366852154
Name:KOESTER, SALLY ELLEN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ELLEN
Last Name:KOESTER
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 1:807 N SULLIVAN RD
Mailing Address - Street 2:#1
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8546
Mailing Address - Country:US
Mailing Address - Phone:509-924-0504
Mailing Address - Fax:
Practice Address - Street 1:807 N SULLIVAN RD
Practice Address - Street 2:#1
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8546
Practice Address - Country:US
Practice Address - Phone:509-924-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60405976225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist