Provider Demographics
NPI:1689406175
Name:DICKINSON, SIENA TREASE (MA61578997)
Entity type:Individual
Prefix:MRS
First Name:SIENA
Middle Name:TREASE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:MA61578997
Other - Prefix:
Other - First Name:SIENA
Other - Middle Name:TREASE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3708 HOME RD UNIT 105
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1012
Mailing Address - Country:US
Mailing Address - Phone:360-500-6739
Mailing Address - Fax:
Practice Address - Street 1:2216 CORNWALL AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3719
Practice Address - Country:US
Practice Address - Phone:360-650-1040
Practice Address - Fax:360-647-1542
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61578997225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist