Provider Demographics
NPI:1851336317
Name:LLABRES-MCDERMOTT, PRISCIA (LMP)
Entity Type:Individual
Prefix:
First Name:PRISCIA
Middle Name:
Last Name:LLABRES-MCDERMOTT
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 1:1111 N NORTHGATE WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8913
Mailing Address - Country:US
Mailing Address - Phone:206-523-2225
Mailing Address - Fax:206-523-9101
Practice Address - Street 1:1111 N NORTHGATE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8913
Practice Address - Country:US
Practice Address - Phone:206-523-2225
Practice Address - Fax:206-523-9101
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA217030OtherL&I NUMBER
WA38-3786781OtherTAX ID
WA0183305OtherL&I NUMBER