Provider Demographics
NPI:1053614917
Name:WOOD, DENISE S
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:S
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9144 BURNETT RD SE # SWTB2
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8488
Mailing Address - Country:US
Mailing Address - Phone:360-400-5800
Mailing Address - Fax:
Practice Address - Street 1:9144 BURNETT RD SE # SWTB2
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8488
Practice Address - Country:US
Practice Address - Phone:360-400-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00014484225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist