Provider Demographics
NPI:1710451745
Name:MAY, ELLEN JEAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:JEAN
Last Name:MAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 S DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5056
Mailing Address - Country:US
Mailing Address - Phone:509-737-7042
Mailing Address - Fax:
Practice Address - Street 1:1601 COLUMBIA PARK TRL STE 101
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4772
Practice Address - Country:US
Practice Address - Phone:509-591-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60861804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60861804OtherWA STATE DEPT OF HEALTH