Provider Demographics
NPI:1871183079
Name:WELLS, SHARON MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:SHARON MARIE
Middle Name:
Last Name:WELLS
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 1:450 W WINTER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7189
Mailing Address - Country:US
Mailing Address - Phone:360-529-7766
Mailing Address - Fax:
Practice Address - Street 1:2210 BLACK LAKE BLVD SW STE G
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5604
Practice Address - Country:US
Practice Address - Phone:360-529-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61022547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist