Healthcare Provider Details

I. General information

NPI: 1366857948
Provider Name (Legal Business Name): RENEE COLLIER LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W PATISON ST
PORT HADLOCK WA
98339-9751
US

IV. Provider business mailing address

909 HENDRICKS ST
PORT TOWNSEND WA
98368-2306
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number00015268
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: