Provider Demographics
NPI:1942363106
Name:MILLS, LOIS CHARLENE (LMT , MMP)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:CHARLENE
Last Name:MILLS
Suffix:
Gender:F
Credentials:LMT , MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 CAMERON STREET
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328-1203
Mailing Address - Country:US
Mailing Address - Phone:509-382-4836
Mailing Address - Fax:
Practice Address - Street 1:109 N. SECOND STREET
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328-1308
Practice Address - Country:US
Practice Address - Phone:509-382-2699
Practice Address - Fax:509-382-2699
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003931225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 00003931OtherMASSAGE THERAPY LICENSE