Provider Demographics
NPI:1689884314
Name:DAVIS, HELEN (MA, LMT)
Entity Type:Individual
Prefix:PROF
First Name:HELEN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4417
Mailing Address - Country:US
Mailing Address - Phone:509-301-7392
Mailing Address - Fax:
Practice Address - Street 1:125 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4417
Practice Address - Country:US
Practice Address - Phone:509-301-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist