Provider Demographics
NPI:1841669447
Name:DUTCHER, SAMANTHA (LMP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DUTCHER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:9860 BUSHLAC LN NW APT F202
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9119 RIDGETOP BLVD NW
Practice Address - Street 2:SUITE 260
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8549
Practice Address - Country:US
Practice Address - Phone:360-979-7069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60523698225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist