Provider Demographics
NPI:1356795959
Name:OLVERA, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:OLVERA
Suffix:
Gender:F
Credentials:
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 68
Mailing Address - Street 2:
Mailing Address - City:WILBUR
Mailing Address - State:WA
Mailing Address - Zip Code:99185-0068
Mailing Address - Country:US
Mailing Address - Phone:509-647-5500
Mailing Address - Fax:509-647-0128
Practice Address - Street 1:100 3RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-5008
Practice Address - Country:US
Practice Address - Phone:509-982-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60471217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist