Provider Demographics
NPI:1548615883
Name:WHEELER, NAOMI0 (MA 0002312)
Entity Type:Individual
Prefix:
First Name:NAOMI0
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MA 0002312
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 BRENTWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3727
Mailing Address - Country:US
Mailing Address - Phone:360-870-9394
Mailing Address - Fax:
Practice Address - Street 1:3006 BRENTWOOD DR SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3727
Practice Address - Country:US
Practice Address - Phone:360-870-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-24
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00023121225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist