Provider Demographics
NPI:1649496167
Name:RICARD, RICHELLE (LMP, CWBT)
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:
Last Name:RICARD
Suffix:
Gender:F
Credentials:LMP, CWBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 EASTLAKE AVE E
Mailing Address - Street 2:STE 233
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3366
Mailing Address - Country:US
Mailing Address - Phone:206-931-2949
Mailing Address - Fax:206-568-7192
Practice Address - Street 1:2366 EASTLAKE AVE E
Practice Address - Street 2:STE 233
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3366
Practice Address - Country:US
Practice Address - Phone:206-931-2949
Practice Address - Fax:206-568-7192
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist