Provider Demographics
NPI:1942417217
Name:AYLMER, MARIANNE (LMP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:AYLMER
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:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:MANSON
Mailing Address - State:WA
Mailing Address - Zip Code:98831
Mailing Address - Country:US
Mailing Address - Phone:509-682-2134
Mailing Address - Fax:509-682-4577
Practice Address - Street 1:417 E.WAPATO STREET
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816
Practice Address - Country:US
Practice Address - Phone:509-682-4577
Practice Address - Fax:509-682-4577
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019691225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty