Provider Demographics
NPI:1720386899
Name:MILLIKEN, PATRICIA SHARLENE
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:SHARLENE
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:SHARLENE
Other - Last Name:MILLIKEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:612 YERGENS RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-8795
Mailing Address - Country:US
Mailing Address - Phone:509-939-3137
Mailing Address - Fax:509-447-2646
Practice Address - Street 1:612 YERGENS RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-8795
Practice Address - Country:US
Practice Address - Phone:509-939-3137
Practice Address - Fax:509-447-2646
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00008657225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist