Provider Demographics
NPI:1861667479
Name:AXLING, SHIRLEY HARRIETA (LMP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:HARRIETA
Last Name:AXLING
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 1:15220 SE 272ND ST
Mailing Address - Street 2:STE G
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4241
Mailing Address - Country:US
Mailing Address - Phone:253-630-6768
Mailing Address - Fax:253-630-6639
Practice Address - Street 1:15220 SE 272ND ST
Practice Address - Street 2:STE G
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-4241
Practice Address - Country:US
Practice Address - Phone:253-630-6768
Practice Address - Fax:253-630-6639
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018161225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist