Provider Demographics
NPI:1770720609
Name:DRAGOO, MICHELLE MARIE (LMP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:DRAGOO
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:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-0214
Mailing Address - Country:US
Mailing Address - Phone:360-887-2135
Mailing Address - Fax:360-887-2984
Practice Address - Street 1:414 PIONEER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-4512
Practice Address - Country:US
Practice Address - Phone:360-887-2135
Practice Address - Fax:360-887-2984
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMAOOO1675225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1508115940OtherNPI 2