Healthcare Provider Details

I. General information

NPI: 1053245407
Provider Name (Legal Business Name): REGINA LENORE DEVEREAUX LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1208
BATTLE GROUND WA
98604-1208
US

IV. Provider business mailing address

PO BOX 1208
BATTLE GROUND WA
98604-1208
US

V. Phone/Fax

Practice location:
  • Phone: 564-219-9547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70069006
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: