Provider Demographics
NPI:1851862361
Name:DELP, AMY JEAN (MA60906187)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:DELP
Suffix:
Gender:F
Credentials:MA60906187
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1745
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-1745
Mailing Address - Country:US
Mailing Address - Phone:509-949-7360
Mailing Address - Fax:
Practice Address - Street 1:607 1ST AVE
Practice Address - Street 2:
Practice Address - City:ZILLAH
Practice Address - State:WA
Practice Address - Zip Code:98953-9433
Practice Address - Country:US
Practice Address - Phone:509-829-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60906187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist