Provider Demographics
NPI:1801014519
Name:SLAVSKY, NINA L (LMP)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:L
Last Name:SLAVSKY
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:PO BOX 1363
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-1363
Mailing Address - Country:US
Mailing Address - Phone:360-470-2757
Mailing Address - Fax:360-754-4703
Practice Address - Street 1:1210 SLEATER KINNEY RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2316
Practice Address - Country:US
Practice Address - Phone:360-352-4511
Practice Address - Fax:360-754-4703
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2010-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019719225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist