Provider Demographics
NPI:1134956725
Name:IRISH, LILI MARLENE
Entity type:Individual
Prefix:
First Name:LILI
Middle Name:MARLENE
Last Name:IRISH
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:MARCO
Other - Middle Name:
Other - Last Name:IRISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3901 15TH AVE S APT 6
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1437
Mailing Address - Country:US
Mailing Address - Phone:206-420-9900
Mailing Address - Fax:
Practice Address - Street 1:160 ROY ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4162
Practice Address - Country:US
Practice Address - Phone:206-453-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61600617225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist