Provider Demographics
NPI:1760780845
Name:VALENTINE, AMBER DAWN (LMP)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:DAWN
Last Name:VALENTINE
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 1:17515 CLEAR LAKE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8976
Mailing Address - Country:US
Mailing Address - Phone:360-894-1543
Mailing Address - Fax:
Practice Address - Street 1:17515 CLEAR LAKE BLVD SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8976
Practice Address - Country:US
Practice Address - Phone:360-894-1543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60209214225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist