Provider Demographics
NPI:1912141755
Name:LEVER, TANYA LAUREN-JOY (LMP)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:LAUREN-JOY
Last Name:LEVER
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 555
Mailing Address - Street 2:
Mailing Address - City:ARIEL
Mailing Address - State:WA
Mailing Address - Zip Code:98603-0555
Mailing Address - Country:US
Mailing Address - Phone:360-608-4422
Mailing Address - Fax:
Practice Address - Street 1:1227 N GOERIG ST
Practice Address - Street 2:SUITE H
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-9741
Practice Address - Country:US
Practice Address - Phone:360-225-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60077399225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist