Basic Information
Provider Information
NPI: 1861715948
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUELLER
FirstName: DAWN
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: LMP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5102 NE 44TH ST
Address2:  
City: SEATTLE
State: WA
PostalCode: 981054921
CountryCode: US
TelephoneNumber: 2063809265
FaxNumber:  
Practice Location
Address1: 1801 NW MARKET ST
Address2: SUITE 408
City: SEATTLE
State: WA
PostalCode: 981073987
CountryCode: US
TelephoneNumber: 2067842800
FaxNumber: 2067842800
Other Information
ProviderEnumerationDate: 03/03/2010
LastUpdateDate: 03/03/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225700000XMA60129807WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist 

No ID Information.


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