Provider Demographics
NPI:1457470791
Name:AUSTIN, EMILY DELENE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:DELENE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:DELENE AUSTIN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:7300 174TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-5125
Mailing Address - Country:US
Mailing Address - Phone:206-914-3570
Mailing Address - Fax:
Practice Address - Street 1:7300 174TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-5125
Practice Address - Country:US
Practice Address - Phone:206-914-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMAOOO13774225700000X
WAMA00013774225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA104659OtherAMTA
WA0152614OtherLABOR AND INDUSTRIES
WAMAOOO13774OtherMASSAGE LICENSE