Provider Demographics
NPI:1467221945
Name:MACY, ANDREA MISCHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MISCHELLE
Last Name:MACY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 NE 116TH PL
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5000
Mailing Address - Country:US
Mailing Address - Phone:360-694-9520
Mailing Address - Fax:
Practice Address - Street 1:16315 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8665
Practice Address - Country:US
Practice Address - Phone:360-882-0767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61478829225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist