Provider Demographics
NPI:1760777023
Name:DEMOTT, JAUNA RAE (LMP)
Entity Type:Individual
Prefix:MS
First Name:JAUNA
Middle Name:RAE
Last Name:DEMOTT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6920 COAL CREEK PKWY SE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3147
Mailing Address - Country:US
Mailing Address - Phone:425-957-7979
Mailing Address - Fax:425-957-0607
Practice Address - Street 1:6920 COAL CREEK PKWY SE
Practice Address - Street 2:SUITE 12
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-3147
Practice Address - Country:US
Practice Address - Phone:425-957-7979
Practice Address - Fax:425-957-0607
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA 60223578225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist