Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 58647 | WA |
NPI | 1013119494 |
---|---|
Provider Name | Betty Jane Hartwell |
First Address | Snohomish, WA 98290-7719 |
Second Address | Sammamish, WA 98075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |