Provider Demographics
NPI:1740400688
Name:HAUKLI, MARIANNE (LMP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:HAUKLI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7490 GLACIER RIDGE PL SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9043
Mailing Address - Country:US
Mailing Address - Phone:360-871-7135
Mailing Address - Fax:
Practice Address - Street 1:2427 BETHEL RD SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2438
Practice Address - Country:US
Practice Address - Phone:360-874-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008281225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA103253OtherDEPT. OF L & I