Provider Demographics
NPI:1750692091
Name:SILVA, DANEEN G (LMP, NCTMB)
Entity type:Individual
Prefix:MS
First Name:DANEEN
Middle Name:G
Last Name:SILVA
Suffix:
Gender:F
Credentials:LMP, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 KELLY LN E
Mailing Address - Street 2:
Mailing Address - City:ALLYN
Mailing Address - State:WA
Mailing Address - Zip Code:98524-9507
Mailing Address - Country:US
Mailing Address - Phone:360-509-6442
Mailing Address - Fax:
Practice Address - Street 1:9414 RIDGETOP BLVD NW STE 103
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8526
Practice Address - Country:US
Practice Address - Phone:360-307-7227
Practice Address - Fax:360-307-8010
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00022746225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist