Provider Demographics
NPI:1629431697
Name:PALMER, TINA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:PALMER
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 1:10702 ROBIN HOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-6162
Mailing Address - Country:US
Mailing Address - Phone:206-818-4084
Mailing Address - Fax:
Practice Address - Street 1:17010 HAMLIN RD NE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-5530
Practice Address - Country:US
Practice Address - Phone:206-818-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60433592225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist