Healthcare Provider Details

I. General information

NPI: 1033171863
Provider Name (Legal Business Name): LILLIAN M CASSIDY LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 N 16TH AVE
YAKIMA WA
98902-1381
US

IV. Provider business mailing address

2811 TIETON DR
YAKIMA WA
98902-3761
US

V. Phone/Fax

Practice location:
  • Phone: 509-574-3300
  • Fax: 509-574-3323
Mailing address:
  • Phone: 509-547-3300
  • Fax: 509-574-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00018275
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: