Provider Demographics
NPI:1609616564
Name:GAILEY, AMELIA (LAC, EAMP)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:GAILEY
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 SW NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2536
Mailing Address - Country:US
Mailing Address - Phone:206-380-5888
Mailing Address - Fax:
Practice Address - Street 1:2626 SW NEVADA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2536
Practice Address - Country:US
Practice Address - Phone:206-380-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV60893493171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist