Healthcare Provider Details

I. General information

NPI: 1720205883
Provider Name (Legal Business Name): RAMONA BARRETT DICKSON LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 KEY PENINSULA HWY N
LAKEBAY WA
98349-9326
US

IV. Provider business mailing address

8903 KEY PENINSULA HWY N
LAKEBAY WA
98349-9326
US

V. Phone/Fax

Practice location:
  • Phone: 360-790-3812
  • Fax: 253-884-2632
Mailing address:
  • Phone: 360-790-3812
  • Fax: 253-884-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00011842
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: