Provider Demographics
NPI:1467626242
Name:RATLEY, DEVON MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:MARIE
Last Name:RATLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19321 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-5553
Mailing Address - Country:US
Mailing Address - Phone:360-887-8600
Mailing Address - Fax:
Practice Address - Street 1:19321 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-5553
Practice Address - Country:US
Practice Address - Phone:360-887-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist