Provider Demographics
NPI:1821641010
Name:OTIS, ANALEIGH MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:ANALEIGH
Middle Name:MICHELLE
Last Name:OTIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 EDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-9610
Mailing Address - Country:US
Mailing Address - Phone:360-460-0082
Mailing Address - Fax:
Practice Address - Street 1:19068 JENSEN WAY NE
Practice Address - Street 2:#4B
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-271-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60950525225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist