Provider Demographics
NPI:1649599762
Name:ADAMS, EUDORA M (LMP)
Entity Type:Individual
Prefix:
First Name:EUDORA
Middle Name:M
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:EUDORA
Other - Middle Name:M
Other - Last Name:BALLOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:12007 149TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-3446
Mailing Address - Country:US
Mailing Address - Phone:206-799-2085
Mailing Address - Fax:
Practice Address - Street 1:12007 149TH ST E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-3446
Practice Address - Country:US
Practice Address - Phone:206-799-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60152831225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist