Provider Demographics
NPI:1437377322
Name:HIATT, PATRICIA B (LMP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:B
Last Name:HIATT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MILLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-0192
Mailing Address - Country:US
Mailing Address - Phone:425-220-1493
Mailing Address - Fax:
Practice Address - Street 1:9212 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-7125
Practice Address - Country:US
Practice Address - Phone:425-353-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019785225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00019785OtherLICENSE NUMBER
WA0215600OtherLABOR AND INDUSTRY ID