Provider Demographics
NPI:1972778439
Name:COPPAGE, WENDY KAYE (LMP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:KAYE
Last Name:COPPAGE
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 1:1100 BELLEVUE WAY NE
Mailing Address - Street 2:STE 8
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4280
Mailing Address - Country:US
Mailing Address - Phone:425-462-4033
Mailing Address - Fax:425-454-0285
Practice Address - Street 1:1100 BELLEVUE WAY NE
Practice Address - Street 2:STE 8
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4280
Practice Address - Country:US
Practice Address - Phone:425-462-4033
Practice Address - Fax:425-454-0285
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021534225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist