Provider Demographics
NPI:1407479959
Name:CASTELLANO, YVONNE MICHELLE
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MICHELLE
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8730 TALLON LN NE STE 104
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-6609
Mailing Address - Country:US
Mailing Address - Phone:360-489-0223
Mailing Address - Fax:
Practice Address - Street 1:8730 TALLON LN NE STE 104
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6609
Practice Address - Country:US
Practice Address - Phone:800-689-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60915705225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist