Provider Demographics
NPI:1205953718
Name:RICKEY, SAMANTHA JEANNE (LMT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JEANNE
Last Name:RICKEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:CHATTAROY
Mailing Address - State:WA
Mailing Address - Zip Code:99003-0282
Mailing Address - Country:US
Mailing Address - Phone:509-570-8515
Mailing Address - Fax:
Practice Address - Street 1:319 W HASTINGS RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2814
Practice Address - Country:US
Practice Address - Phone:509-570-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602492109174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist