Provider Demographics
NPI:1992856538
Name:WOODY, MARJORIE KAY (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:KAY
Last Name:WOODY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:KAY
Other - Last Name:MADSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19201 108TH AVE SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-7379
Mailing Address - Country:US
Mailing Address - Phone:253-859-6441
Mailing Address - Fax:253-859-9437
Practice Address - Street 1:19201 108TH AVE SE
Practice Address - Street 2:SUITE 101
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-7379
Practice Address - Country:US
Practice Address - Phone:253-859-6441
Practice Address - Fax:253-859-9437
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist