Provider Demographics
NPI:1548499734
Name:NEVILLE, MICHELLE (LMP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ISHELL
Other - Middle Name:
Other - Last Name:NEVILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2206 QUEEN ANNE AVE N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2370
Mailing Address - Country:US
Mailing Address - Phone:206-378-5755
Mailing Address - Fax:206-219-0556
Practice Address - Street 1:2206 QUEEN ANNE AVE N
Practice Address - Street 2:SUITE 202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2370
Practice Address - Country:US
Practice Address - Phone:206-378-5755
Practice Address - Fax:206-219-0556
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016612225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist