Healthcare Provider Details

I. General information

NPI: 1346302015
Provider Name (Legal Business Name): ERIN M AVELLE LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN A THOMPSON LMP

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 D ST NE SUITE 101
AUBURN WA
98002-4163
US

IV. Provider business mailing address

32533 107TH AVE SE
AUBURN WA
98092-4726
US

V. Phone/Fax

Practice location:
  • Phone: 253-939-0906
  • Fax:
Mailing address:
  • Phone: 253-833-6722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00020482
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: