Provider Demographics
NPI:1508117516
Name:MCDONALD, MOLLY BETH (LMP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:BETH
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:108 FACTORY AVE N
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5551
Mailing Address - Country:US
Mailing Address - Phone:425-228-2824
Mailing Address - Fax:425-228-6956
Practice Address - Street 1:108 FACTORY AVE N
Practice Address - Street 2:SUITE 2A
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5551
Practice Address - Country:US
Practice Address - Phone:425-228-2824
Practice Address - Fax:425-228-6956
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA60308573225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist