Provider Demographics
NPI:1760895304
Name:FIELDING, LAURA LIANE (LMP, CCST)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LIANE
Last Name:FIELDING
Suffix:
Gender:F
Credentials:LMP, CCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 S HOSMER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3150
Mailing Address - Country:US
Mailing Address - Phone:253-666-2031
Mailing Address - Fax:
Practice Address - Street 1:2335 S HOSMER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3150
Practice Address - Country:US
Practice Address - Phone:253-666-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60448820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist