Provider Demographics
NPI:1952599334
Name:HEATON, BAMBI E (LMP)
Entity Type:Individual
Prefix:
First Name:BAMBI
Middle Name:E
Last Name:HEATON
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 1:15620 HWY 99
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-1475
Mailing Address - Country:US
Mailing Address - Phone:425-743-3091
Mailing Address - Fax:
Practice Address - Street 1:15620 HWY 99
Practice Address - Street 2:SUITE 6A
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-1475
Practice Address - Country:US
Practice Address - Phone:425-743-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023342225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist