Provider Demographics
NPI:1740621416
Name:DILLAHUNTY, NICHOLE MARGIT (LMP)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARGIT
Last Name:DILLAHUNTY
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 1:8207 38TH STREET CT W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-2066
Mailing Address - Country:US
Mailing Address - Phone:253-283-9211
Mailing Address - Fax:
Practice Address - Street 1:8207 38TH STREET CT W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-2066
Practice Address - Country:US
Practice Address - Phone:253-283-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist