Provider Demographics
NPI:1780809756
Name:KING, SHEILA BLAKE (LMP)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:BLAKE
Last Name:KING
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:SHEILA
Other - Middle Name:KAYE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:WA
Mailing Address - Zip Code:98220-0174
Mailing Address - Country:US
Mailing Address - Phone:360-927-2727
Mailing Address - Fax:360-595-2274
Practice Address - Street 1:119 N COMMERCIAL ST
Practice Address - Street 2:SUITE 320
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4446
Practice Address - Country:US
Practice Address - Phone:360-927-2727
Practice Address - Fax:360-595-2274
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist