Provider Demographics
NPI:1417021668
Name:ORR, NANCY JEAN (LMP, NCBTMB)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:ORR
Suffix:
Gender:F
Credentials:LMP, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9692
Mailing Address - Country:US
Mailing Address - Phone:360-391-3633
Mailing Address - Fax:360-856-1539
Practice Address - Street 1:2118 RIVERSIDE DR
Practice Address - Street 2:SUITE #105
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5454
Practice Address - Country:US
Practice Address - Phone:360-424-6104
Practice Address - Fax:360-424-6009
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0205627OtherDEPT. OF L & I PROVIDER #