Provider Demographics
NPI:1245358977
Name:MCCUSKER, LORI MARIE (LMP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:MARIE
Last Name:MCCUSKER
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 1:694 S MARKET BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3418
Mailing Address - Country:US
Mailing Address - Phone:360-740-0613
Mailing Address - Fax:360-740-0613
Practice Address - Street 1:694 S MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3418
Practice Address - Country:US
Practice Address - Phone:360-740-0613
Practice Address - Fax:360-740-0613
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005498225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA12770OtherLABOR&INDUSTRIES
WAMC6071OtherREGENCE BLUE SHGIELD
WA8925121OtherL&I CRIME VICTIMS