Provider Demographics
NPI:1508267725
Name:ELIAS, TAMI
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:
Last Name:ELIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9607 STEIN RD
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98240-9247
Mailing Address - Country:US
Mailing Address - Phone:360-303-4133
Mailing Address - Fax:
Practice Address - Street 1:8862 BENDER RD
Practice Address - Street 2:101
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264
Practice Address - Country:US
Practice Address - Phone:360-354-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006252225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist