Provider Demographics
NPI:1750971123
Name:DEPETTER, FRAUKE CHRISTA (LMT)
Entity type:Individual
Prefix:
First Name:FRAUKE
Middle Name:CHRISTA
Last Name:DEPETTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 464
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98568-0464
Mailing Address - Country:US
Mailing Address - Phone:360-508-2997
Mailing Address - Fax:
Practice Address - Street 1:1607 COOPER POINT RD NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8325
Practice Address - Country:US
Practice Address - Phone:360-508-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61011661225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist