Provider Demographics
NPI:1134382674
Name:BOLING, WHITNEY MICHELLE (LMP)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MICHELLE
Last Name:BOLING
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:MICHELLE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:418 CARPENTER RD SE
Mailing Address - Street 2:STE 102
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7905
Mailing Address - Country:US
Mailing Address - Phone:360-350-2968
Mailing Address - Fax:360-539-7729
Practice Address - Street 1:418 CARPENTER RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-7905
Practice Address - Country:US
Practice Address - Phone:360-350-2968
Practice Address - Fax:360-539-7729
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60012493225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist