Provider Demographics
NPI:1851684633
Name:LAISY, SIERRA ROSE (LMP)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:ROSE
Last Name:LAISY
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 1:5821 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-2755
Mailing Address - Country:US
Mailing Address - Phone:253-863-0991
Mailing Address - Fax:
Practice Address - Street 1:16202 64TH ST E
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3028
Practice Address - Country:US
Practice Address - Phone:206-310-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60095922225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist