Provider Demographics
NPI:1477883551
Name:ORDWAY, PAULA SUE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:SUE
Last Name:ORDWAY
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 1:4611 E PINEGLEN LN
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-9417
Mailing Address - Country:US
Mailing Address - Phone:509-954-2161
Mailing Address - Fax:
Practice Address - Street 1:4611 E PINEGLEN LN
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:WA
Practice Address - Zip Code:99021-9417
Practice Address - Country:US
Practice Address - Phone:509-954-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60044884225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist