Provider Demographics
NPI:1629113097
Name:OLTMANN, ELISHA DANYEIL (LMP)
Entity Type:Individual
Prefix:MISS
First Name:ELISHA
Middle Name:DANYEIL
Last Name:OLTMANN
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:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98291-0886
Mailing Address - Country:US
Mailing Address - Phone:425-210-1084
Mailing Address - Fax:
Practice Address - Street 1:3527 ROBE MENZEL RD
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252-9418
Practice Address - Country:US
Practice Address - Phone:425-210-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016969225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist