Provider Demographics
NPI:1467588210
Name:GATCHELL, NICOLE DALLAS JUNE (LMT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DALLAS JUNE
Last Name:GATCHELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DIAHNE
Other - Last Name:GATCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-0906
Mailing Address - Country:US
Mailing Address - Phone:253-592-0606
Mailing Address - Fax:
Practice Address - Street 1:105B W MAIN STE 101
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5329
Practice Address - Country:US
Practice Address - Phone:253-592-0606
Practice Address - Fax:253-954-3030
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010209225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALABOR & INDUSTRIESOther132868