MEDICARE: DEANNA IRENE CLASBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00020213	WA

General Provider Information

NPI Number	:	1003944059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA IRENE CLASBY

Provider Business Mailing Address
First Line	:	103 E HOLLY ST
Second Line	:	404
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4728
Country	:	US
Telephone Number	:	360-224-1363
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 E HOLLY ST
Second Line	:	404
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4728
Country	:	US
Telephone Number	:	360-224-1363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	04/10/2017

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