Provider Demographics
NPI:1962832097
Name:RHOADES, BRENDA JAYNE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JAYNE
Last Name:RHOADES
Suffix:
Gender:F
Credentials:
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 219
Mailing Address - Street 2:
Mailing Address - City:TAHOLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98587-0219
Mailing Address - Country:US
Mailing Address - Phone:360-276-4405
Mailing Address - Fax:
Practice Address - Street 1:1505 KLA-OOK-WA DRIVE
Practice Address - Street 2:
Practice Address - City:TAHOLAH
Practice Address - State:WA
Practice Address - Zip Code:98587-0219
Practice Address - Country:US
Practice Address - Phone:360-276-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009150225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist