Provider Demographics
NPI:1568707123
Name:HAMELIN, PATRICIA CECILIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CECILIA
Last Name:HAMELIN
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 1:1825 SE 164TH AVE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8602
Mailing Address - Country:US
Mailing Address - Phone:360-892-0100
Mailing Address - Fax:
Practice Address - Street 1:1825 SE 164TH AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8602
Practice Address - Country:US
Practice Address - Phone:360-892-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005909225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist