Provider Demographics
NPI:1558663914
Name:WIESINGER, PAULETTE KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:KATHLEEN
Last Name:WIESINGER
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 1:11804 COUNTY LINE RD E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98372
Mailing Address - Country:US
Mailing Address - Phone:253-952-9194
Mailing Address - Fax:206-260-0200
Practice Address - Street 1:11804 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98372-1255
Practice Address - Country:US
Practice Address - Phone:253-952-9194
Practice Address - Fax:206-260-0200
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60191719225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist