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NPI Code Detail

MEDICARE: SAMANTHA DELLA-DEVONEY L.M.P.

MEDICARE:   SAMANTHA  DELLA-DEVONEY  L.M.P.
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
1225700000XMassage TherapistMA60446763WA

General Provider Information

NPI Number : 1205252434
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA DELLA-DEVONEY L.M.P.
Provider Business Mailing Address
First Line : 1012 W 15TH ST
Second Line :
City : PORT ANGELES
State : WA
Zip : 98363-7232
Country : US
Telephone Number : 360-640-2968
Fax Number :
Provider Business Practice Location Address
First Line : 1012 W 15TH ST
Second Line :
City : PORT ANGELES
State : WA
Zip : 98363-7232
Country : US
Telephone Number : 360-640-2968
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2014
Last Update Date : 03/12/2014

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Directions to “ SAMANTHA DELLA-DEVONEY L.M.P.” Practice Location

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