Provider Demographics
NPI:1487841623
Name:EILERS, LETA KAYE (MA00024665)
Entity Type:Individual
Prefix:MRS
First Name:LETA
Middle Name:KAYE
Last Name:EILERS
Suffix:
Gender:F
Credentials:MA00024665
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16431 SE 235TH ST.
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042
Mailing Address - Country:US
Mailing Address - Phone:253-740-8373
Mailing Address - Fax:253-631-7920
Practice Address - Street 1:17039 SE 272ND ST
Practice Address - Street 2:SUITE 104
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-7348
Practice Address - Country:US
Practice Address - Phone:253-740-8373
Practice Address - Fax:253-631-7920
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024665225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist