Provider Demographics
NPI:1902962137
Name:MANION, STEPHANIE OLIVE (MHP, LMP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:OLIVE
Last Name:MANION
Suffix:
Gender:F
Credentials:MHP, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 TAYLOR AVE N
Mailing Address - Street 2:APT 204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-6002
Mailing Address - Country:US
Mailing Address - Phone:206-283-0851
Mailing Address - Fax:
Practice Address - Street 1:1600 DEXTER AVE N
Practice Address - Street 2:SUITE C-4
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3079
Practice Address - Country:US
Practice Address - Phone:206-499-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010899225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist