Provider Demographics
NPI:1134371909
Name:BITTNER, WILLOW (LMP)
Entity type:Individual
Prefix:
First Name:WILLOW
Middle Name:
Last Name:BITTNER
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 1:707 E ROY ST
Mailing Address - Street 2:APT 6
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4683
Mailing Address - Country:US
Mailing Address - Phone:206-915-2187
Mailing Address - Fax:
Practice Address - Street 1:1205 E PIKE ST
Practice Address - Street 2:SUITE 2J
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3900
Practice Address - Country:US
Practice Address - Phone:206-915-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist