Provider Demographics
NPI:1376046458
Name:PARKER, ANNETTE LILJA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:LILJA
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 CASTEEL RD
Mailing Address - Street 2:
Mailing Address - City:TERRA ALTA
Mailing Address - State:WV
Mailing Address - Zip Code:26764-6175
Mailing Address - Country:US
Mailing Address - Phone:304-777-7133
Mailing Address - Fax:
Practice Address - Street 1:114 ALPINE LAKE RD
Practice Address - Street 2:
Practice Address - City:TERRA ALTA
Practice Address - State:WV
Practice Address - Zip Code:26764-7700
Practice Address - Country:US
Practice Address - Phone:304-777-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2018-3595225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist