Provider Demographics
NPI:1942774906
Name:COPELAND, STEPHANIE CHRISTINE (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CHRISTINE
Last Name:COPELAND
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 1:4001 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1894
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1894
Practice Address - Country:US
Practice Address - Phone:360-693-3030
Practice Address - Fax:360-828-1305
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1942774906225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA05181992OtherLICENSE MASSAGE THERAPIST