Provider Demographics
NPI:1922391929
Name:WAUD-BERRY, DIANA FRANCES (LMP,LMT)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:FRANCES
Last Name:WAUD-BERRY
Suffix:
Gender:F
Credentials:LMP,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SE 283RD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9509
Mailing Address - Country:US
Mailing Address - Phone:360-834-7621
Mailing Address - Fax:
Practice Address - Street 1:1901 SE 283RD AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-9509
Practice Address - Country:US
Practice Address - Phone:360-834-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60213795225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist