Provider Demographics
NPI:1912107590
Name:MATHERS, SHERICE RENEE (LMP)
Entity Type:Individual
Prefix:MS
First Name:SHERICE
Middle Name:RENEE
Last Name:MATHERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:SHERICE
Other - Middle Name:RENEE
Other - Last Name:HOLDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:406 EVANS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:WA
Mailing Address - Zip Code:98591-9515
Mailing Address - Country:US
Mailing Address - Phone:360-880-1809
Mailing Address - Fax:360-864-8879
Practice Address - Street 1:145 LILLY RD NE
Practice Address - Street 2:SUITE 101
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5028
Practice Address - Country:US
Practice Address - Phone:360-880-1809
Practice Address - Fax:360-864-8879
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023932174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
603272625OtherSHERICE'S MASSAGE