Provider Demographics
NPI:1720733058
Name:TICKLE, DEBRA LEA (LMT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LEA
Last Name:TICKLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15230 NE 24TH ST STE S-1
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5540
Mailing Address - Country:US
Mailing Address - Phone:425-827-2225
Mailing Address - Fax:425-283-4192
Practice Address - Street 1:15230 NE 24TH ST STE S-1
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5540
Practice Address - Country:US
Practice Address - Phone:425-827-2225
Practice Address - Fax:425-283-4192
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61194237225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist