Provider Demographics
NPI:1457560211
Name:OGDEE, REBECCA (LMP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:OGDEE
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 1:3106 NE 179TH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-9527
Mailing Address - Country:US
Mailing Address - Phone:360-573-5984
Mailing Address - Fax:
Practice Address - Street 1:11818 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE #408
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5089
Practice Address - Country:US
Practice Address - Phone:360-254-0616
Practice Address - Fax:360-254-0618
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023428225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist