Provider Demographics
NPI:1689722837
Name:TILLINGHAST, DARLA A (LMP)
Entity Type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:A
Last Name:TILLINGHAST
Suffix:
Gender:F
Credentials:LMP
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Mailing Address - Street 1:3773 MARTIN WAY E
Mailing Address - Street 2:SUITE B-106
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5048
Mailing Address - Country:US
Mailing Address - Phone:360-352-8896
Mailing Address - Fax:360-705-0633
Practice Address - Street 1:3773 MARTIN WAY E
Practice Address - Street 2:SUITE B-106
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5048
Practice Address - Country:US
Practice Address - Phone:360-352-8896
Practice Address - Fax:360-705-0633
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2012-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMA00019956225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist