Provider Demographics
NPI:1760858831
Name:HAIR, NEVIN MICHAEL (LMP)
Entity Type:Individual
Prefix:
First Name:NEVIN
Middle Name:MICHAEL
Last Name:HAIR
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11502 ASHTON AVE E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6144
Mailing Address - Country:US
Mailing Address - Phone:253-737-7173
Mailing Address - Fax:
Practice Address - Street 1:6314 19TH ST W
Practice Address - Street 2:SUITE# 11
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6223
Practice Address - Country:US
Practice Address - Phone:253-267-8188
Practice Address - Fax:253-267-8187
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60546704225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist