Provider Demographics
NPI:1013117761
Name:TUTTLE, AMY L (LMP, LMT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:LMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4827
Mailing Address - Country:US
Mailing Address - Phone:360-258-0478
Mailing Address - Fax:360-859-1715
Practice Address - Street 1:1918 NW JOHNSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1308
Practice Address - Country:US
Practice Address - Phone:360-448-3083
Practice Address - Fax:360-859-1715
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019248225700000X
OR14108225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist