Provider Demographics
NPI:1770704405
Name:RICHMON, AMBER MARGO (LMP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARGO
Last Name:RICHMON
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 1:5505 238TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5252
Mailing Address - Country:US
Mailing Address - Phone:206-533-8878
Mailing Address - Fax:206-533-8378
Practice Address - Street 1:5505 238TH ST SW
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5252
Practice Address - Country:US
Practice Address - Phone:206-533-8878
Practice Address - Fax:206-533-8378
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022714225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist