Provider Demographics
NPI:1669686648
Name:OUIDA, MARCA ELAINE (PTA, LMP)
Entity Type:Individual
Prefix:
First Name:MARCA
Middle Name:ELAINE
Last Name:OUIDA
Suffix:
Gender:F
Credentials:PTA, 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 394
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:WA
Mailing Address - Zip Code:98050-0394
Mailing Address - Country:US
Mailing Address - Phone:425-441-8026
Mailing Address - Fax:
Practice Address - Street 1:8404 308TH AVE SE
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:WA
Practice Address - Zip Code:98050
Practice Address - Country:US
Practice Address - Phone:425-441-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
WAMA00022292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist