Provider Demographics
NPI:1952635476
Name:KEELEY, NATASHA LEANN (LMP)
Entity Type:Individual
Prefix:MISS
First Name:NATASHA
Middle Name:LEANN
Last Name:KEELEY
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 1:7920 WOODS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-9053
Mailing Address - Country:US
Mailing Address - Phone:425-327-1547
Mailing Address - Fax:
Practice Address - Street 1:111 AVENUE C STE 103
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2766
Practice Address - Country:US
Practice Address - Phone:360-862-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60103764225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist