Provider Demographics
NPI:1376848630
Name:DILLEY, JOANNE KAY (LMP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:KAY
Last Name:DILLEY
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 1:3630 S 268TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-7035
Mailing Address - Country:US
Mailing Address - Phone:206-595-5507
Mailing Address - Fax:206-772-2073
Practice Address - Street 1:401 OLYMPIA AVE NE
Practice Address - Street 2:SUITE 316
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4117
Practice Address - Country:US
Practice Address - Phone:206-595-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60188177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist