Provider Demographics
NPI:1679824783
Name:ADAMS, CORTNEY LAUREN (LMP)
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:LAUREN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 GRIFFIN AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022
Mailing Address - Country:US
Mailing Address - Phone:253-720-4066
Mailing Address - Fax:
Practice Address - Street 1:1156 GRIFFIN AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022
Practice Address - Country:US
Practice Address - Phone:253-720-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA#60261306225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist