Provider Demographics
NPI:1508212218
Name:ETTA, SARAHLYNN MELIAI (LMP)
Entity Type:Individual
Prefix:MISS
First Name:SARAHLYNN
Middle Name:MELIAI
Last Name:ETTA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
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Mailing Address - Street 1:8606 145TH ST NW
Mailing Address - Street 2:B
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98329
Mailing Address - Country:US
Mailing Address - Phone:907-748-1831
Mailing Address - Fax:907-222-5412
Practice Address - Street 1:2727 HOLLYCROFT STREET
Practice Address - Street 2:#310
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-514-6757
Practice Address - Fax:907-222-5412
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK101404225700000X
WAMA60672328225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist