Provider Demographics
NPI:1659597862
Name:VELEY, SUSIE A (LMP NCTMB)
Entity Type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:A
Last Name:VELEY
Suffix:
Gender:F
Credentials:LMP NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SW SECOND STREET
Mailing Address - Street 2:PO BOX 1021
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648
Mailing Address - Country:US
Mailing Address - Phone:509-427-7992
Mailing Address - Fax:509-427-7992
Practice Address - Street 1:225 SW SECOND
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648
Practice Address - Country:US
Practice Address - Phone:509-427-7992
Practice Address - Fax:509-427-7992
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist