Healthcare Provider Details

I. General information

NPI: 1679488654
Provider Name (Legal Business Name): DARYEN ISABELLE RANDALL LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S ROOSEVELT ST
GOLDENDALE WA
98620-9201
US

IV. Provider business mailing address

11 HARRIS RD
GOLDENDALE WA
98620-3217
US

V. Phone/Fax

Practice location:
  • Phone: 509-773-4022
  • Fax:
Mailing address:
  • Phone: 541-993-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number28903
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA.70025486
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: