Provider Demographics
NPI:1659622090
Name:LEMON, AMELIA MARIE (PTA)
Entity Type:Individual
Prefix:MS
First Name:AMELIA
Middle Name:MARIE
Last Name:LEMON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LAKE LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2781
Mailing Address - Country:US
Mailing Address - Phone:360-303-4164
Mailing Address - Fax:
Practice Address - Street 1:22 LAKE LOUISE DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-2781
Practice Address - Country:US
Practice Address - Phone:360-303-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160078802225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP160078802OtherSTATE LICENSE NUMBER