Healthcare Provider Details

I. General information

NPI: 1508825209
Provider Name (Legal Business Name): ELIZABETH WINTOR DAILEY L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 SE SUMMIT CT
PULLMAN WA
99163-5519
US

IV. Provider business mailing address

1620 SE SUMMIT CT
PULLMAN WA
99163-5519
US

V. Phone/Fax

Practice location:
  • Phone: 509-334-4098
  • Fax:
Mailing address:
  • Phone: 509-334-4098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00010593
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: