Provider Demographics
NPI:1467754804
Name:TAHKEAL, MARY ANN (LMP, CNMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:TAHKEAL
Suffix:
Gender:F
Credentials:LMP, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 W NOB HILL BLVD
Mailing Address - Street 2:UNIT # 117
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-1957
Mailing Address - Country:US
Mailing Address - Phone:509-594-0325
Mailing Address - Fax:
Practice Address - Street 1:915 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3021
Practice Address - Country:US
Practice Address - Phone:509-469-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60260772225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist