Provider Demographics
NPI:1023240231
Name:HAYES, SELENA BETH HAWKS (LMP)
Entity type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:BETH HAWKS
Last Name:HAYES
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 1:19230 SE 48TH PL
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-9362
Mailing Address - Country:US
Mailing Address - Phone:206-841-7292
Mailing Address - Fax:
Practice Address - Street 1:19230 SE 48TH PL
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-9362
Practice Address - Country:US
Practice Address - Phone:206-841-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022564225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist