Provider Demographics
NPI:1942471156
Name:TEETER, REBECCA (LMP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TEETER
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 1:100 S I ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6502
Mailing Address - Country:US
Mailing Address - Phone:360-532-1707
Mailing Address - Fax:360-532-1703
Practice Address - Street 1:100 S I ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6502
Practice Address - Country:US
Practice Address - Phone:360-532-1707
Practice Address - Fax:360-532-1703
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020933225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist