Provider Demographics
NPI:1548499239
Name:DILLMON, NATASHA KAE (LMP)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:KAE
Last Name:DILLMON
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 1:7801 NE 166TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-1525
Mailing Address - Country:US
Mailing Address - Phone:360-909-0544
Mailing Address - Fax:
Practice Address - Street 1:9418 NE VANCOUVER MALL DR STE 105
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6182
Practice Address - Country:US
Practice Address - Phone:360-260-6903
Practice Address - Fax:360-260-4849
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist