Provider Demographics
NPI:1881853125
Name:JACOBSON, PAIGE ONVIA (LMP)
Entity type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:ONVIA
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:ONVIA
Other - Last Name:WELSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:5014 BLUE SAGE DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4015
Mailing Address - Country:US
Mailing Address - Phone:360-480-4251
Mailing Address - Fax:
Practice Address - Street 1:5014 BLUE SAGE DR
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4015
Practice Address - Country:US
Practice Address - Phone:360-480-4251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024575225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist