Provider Demographics
NPI:1487057543
Name:COREY, AMBER (LMP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:COREY
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 1:40 SW CASCADE AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-6284
Mailing Address - Country:US
Mailing Address - Phone:360-865-9706
Mailing Address - Fax:
Practice Address - Street 1:40 SW CASCADE AVE
Practice Address - Street 2:UNIT D
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-6284
Practice Address - Country:US
Practice Address - Phone:360-865-9706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024433225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist