Provider Demographics
NPI:1447467188
Name:LEE, D LYN DYAN (LMP)
Entity type:Individual
Prefix:
First Name:D LYN
Middle Name:DYAN
Last Name:LEE
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 1:1408 LAKE TAPPS PARKWAY E
Mailing Address - Street 2:SUITE E106
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092
Mailing Address - Country:US
Mailing Address - Phone:253-939-7179
Mailing Address - Fax:253-939-7182
Practice Address - Street 1:1408 LAKE TAPPS PARKWAY EAST
Practice Address - Street 2:SUITE E106
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092
Practice Address - Country:US
Practice Address - Phone:253-939-7179
Practice Address - Fax:253-939-7182
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010426225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
610775200OtherUSDOL
WA0203403OtherL&I