Provider Demographics
NPI:1578808382
Name:BAUER, SHERYL MARLENE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:MARLENE
Last Name:BAUER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MRS
Other - First Name:SHERYL
Other - Middle Name:M
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:426 MILLER ROAD
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250
Mailing Address - Country:US
Mailing Address - Phone:360-378-6633
Mailing Address - Fax:
Practice Address - Street 1:640 MULLIS ST
Practice Address - Street 2:SUITE 219
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-7940
Practice Address - Country:US
Practice Address - Phone:360-378-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0001052174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist