Healthcare Provider Details

I. General information

NPI: 1295698843
Provider Name (Legal Business Name): DANIELLE LEE HILLIARD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CUSTER WAY SW
TUMWATER WA
98501-3330
US

IV. Provider business mailing address

PO BOX 267 PMB 11212
OLYMPIA WA
98507
US

V. Phone/Fax

Practice location:
  • Phone: 360-706-4716
  • Fax:
Mailing address:
  • Phone: 360-706-4716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70063437
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: