Provider Demographics
NPI:1629263728
Name:LIZOTTE, DELORIS ANN
Entity Type:Individual
Prefix:
First Name:DELORIS
Middle Name:ANN
Last Name:LIZOTTE
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 1:15683 FIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-9150
Mailing Address - Country:US
Mailing Address - Phone:360-766-6444
Mailing Address - Fax:360-766-4205
Practice Address - Street 1:516 MORRIS STREET
Practice Address - Street 2:
Practice Address - City:LACONNER
Practice Address - State:WA
Practice Address - Zip Code:98257
Practice Address - Country:US
Practice Address - Phone:360-446-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011791225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist