Provider Demographics
NPI:1750549465
Name:PADDOCK, JOLIEN R (LMP)
Entity type:Individual
Prefix:MS
First Name:JOLIEN
Middle Name:R
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:JODI
Other - Middle Name:R
Other - Last Name:PADDOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:39110 244TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-8858
Mailing Address - Country:US
Mailing Address - Phone:253-569-3625
Mailing Address - Fax:
Practice Address - Street 1:1724 COLE ST
Practice Address - Street 2:SUITE #6
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3554
Practice Address - Country:US
Practice Address - Phone:253-569-3625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007843225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist