Provider Demographics
NPI:1902014228
Name:GRIBBLE, EILEEN (LMT)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:GRIBBLE
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 1:119 N COMMERCIAL ST
Mailing Address - Street 2:SUITE 370
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4446
Mailing Address - Country:US
Mailing Address - Phone:360-739-2986
Mailing Address - Fax:
Practice Address - Street 1:119 N COMMERCIAL ST
Practice Address - Street 2:SUITE 370
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4446
Practice Address - Country:US
Practice Address - Phone:360-739-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004836174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00004836OtherMASSAGE LICENSE