Provider Demographics
NPI:1578826160
Name:DIEHL, LENA MAIRE (LMP)
Entity Type:Individual
Prefix:MS
First Name:LENA
Middle Name:MAIRE
Last Name:DIEHL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 96TH ST S
Mailing Address - Street 2:APT # G-24
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-1722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2430 96TH ST S
Practice Address - Street 2:APT # G-24
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-1722
Practice Address - Country:US
Practice Address - Phone:253-291-6319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60204215225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist