Healthcare Provider Details

I. General information

NPI: 1043599665
Provider Name (Legal Business Name): DONEAL HALEY PUTNAM LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 11/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 ORCAS AVE
PORT ANGELES WA
98362-6511
US

IV. Provider business mailing address

430 ORCAS AVE
PORT ANGELES WA
98362-6511
US

V. Phone/Fax

Practice location:
  • Phone: 360-460-3762
  • Fax:
Mailing address:
  • Phone: 360-460-3762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60192672
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: