Provider Demographics
NPI:1760642789
Name:AYERS, AHWREN (LMP)
Entity Type:Individual
Prefix:
First Name:AHWREN
Middle Name:
Last Name:AYERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:AHWREN
Other - Middle Name:
Other - Last Name:GAILYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6171 NORTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248
Mailing Address - Country:US
Mailing Address - Phone:360-312-1244
Mailing Address - Fax:
Practice Address - Street 1:6171 NORTHWEST DR
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248
Practice Address - Country:US
Practice Address - Phone:360-312-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00001039225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist