Provider Demographics
NPI:1407076912
Name:HOLLAND, DESIRE ADRIENNA (LMT LMP)
Entity Type:Individual
Prefix:MISS
First Name:DESIRE
Middle Name:ADRIENNA
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LMT LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12305 120TH AVE NE
Mailing Address - Street 2:#A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-820-2777
Mailing Address - Fax:425-821-5528
Practice Address - Street 1:12305 120TH AVE NE
Practice Address - Street 2:#A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-820-2777
Practice Address - Fax:425-821-5528
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020873225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0205830OtherL & I