Provider Demographics
NPI:1518788520
Name:WOLF, LYNNE FONTAINE (LMT)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:FONTAINE
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8319 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:LYLE
Mailing Address - State:WA
Mailing Address - Zip Code:98635-9626
Mailing Address - Country:US
Mailing Address - Phone:541-340-9140
Mailing Address - Fax:
Practice Address - Street 1:1625 WOODS CT
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2919
Practice Address - Country:US
Practice Address - Phone:503-200-9754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27906225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist