Provider Demographics
NPI:1952146573
Name:IRELAND, MARIAH DEE
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:DEE
Last Name:IRELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 12TH AVE S UNIT A209
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2990
Mailing Address - Country:US
Mailing Address - Phone:574-870-7632
Mailing Address - Fax:
Practice Address - Street 1:1300 S 320TH ST STE B
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5359
Practice Address - Country:US
Practice Address - Phone:253-839-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPTIP.PU.61564402390200000X
WAPT.61564401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program