Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00017852 | WA |
NPI | 1003952789 |
---|---|
Provider Name | Arin M D'avino |
First Address | Port Orchard, WA 98366-0525 |
Second Address | Port Orchard, WA 98366-3909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0169804 | LABOR AND INDUSTRIES (01) | WA |
91-1180427-10 | KPS (01) | WA |
MA00017852 | LMP LICENSE (01) | WA |