Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60201084 | WA |
NPI | 1003198656 |
---|---|
Provider Name | Amanda Killen |
First Address | Seattle, WA 98115-6423 |
Second Address | Seattle, WA 98103-6569 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2011 |
Last Update Date | 09/09/2011 |