Provider Demographics
NPI:1629309364
Name:SCHACTLER, ALLISON YVONNE (LMP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:YVONNE
Last Name:SCHACTLER
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 1414
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-1414
Mailing Address - Country:US
Mailing Address - Phone:360-893-5300
Mailing Address - Fax:360-893-5314
Practice Address - Street 1:215 WHITESELL ST NW STE C102
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-9329
Practice Address - Country:US
Practice Address - Phone:360-893-5300
Practice Address - Fax:360-893-5314
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60118721225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist