Provider Demographics
NPI:1821563800
Name:LILLEY, TRICIA LYNN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LYNN
Last Name:LILLEY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15912 SE 2ND ST APT H
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-8877
Mailing Address - Country:US
Mailing Address - Phone:818-620-6128
Mailing Address - Fax:
Practice Address - Street 1:11504 SE MILL PLAIN BLVD STE 1E
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5081
Practice Address - Country:US
Practice Address - Phone:818-620-6128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60875468225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60875468OtherMASSAGE THERAPIST LICENSE