Provider Demographics
NPI:1801037098
Name:AHEARN-SPECTOR, ALISA DEWON (LMP)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:DEWON
Last Name:AHEARN-SPECTOR
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 1:15822 CRESCENT VALLEY DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-9748
Mailing Address - Country:US
Mailing Address - Phone:253-857-7151
Mailing Address - Fax:253-857-2318
Practice Address - Street 1:15822 CRESCENT VALLEY DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-9748
Practice Address - Country:US
Practice Address - Phone:253-857-7151
Practice Address - Fax:253-857-2318
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist