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General NPI Number Information
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NPI Number | 1205244258
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Entity Type | Individual
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Provider Name | DANIELLE NICOLE DICKEN
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Gender | Female
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 13909 MERIDIAN E STE A2
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City | PUYALLUP
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State | WA
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Zip | 98373-9180
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Country | US
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Telephone | 253-720-9912
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Fax | 253-922-4273
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Provider Business Mailing Address
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Address Line | 13105 206TH ST E
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City | GRAHAM
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State | WA
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Zip | 98338-7752
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Country | US
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Telephone | 253-720-9912
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Fax | 253-922-4273
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60479869
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License Number State | WA
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