Provider Demographics
NPI:1457585887
Name:KAGELE, DEANA (LMP)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:KAGELE
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 1:3330 W COURT ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3875
Mailing Address - Country:US
Mailing Address - Phone:509-845-4130
Mailing Address - Fax:
Practice Address - Street 1:3330 W COURT ST
Practice Address - Street 2:SUITE L
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3875
Practice Address - Country:US
Practice Address - Phone:509-845-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019980225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist