Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 60319993 | WA |
NPI | 1003169483 |
---|---|
Provider Name | Brita Marie Hanson |
First Address | Aberdeen, WA 98520-0246 |
Second Address | Aberdeen, WA 98520-3933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2012 |
Last Update Date | 22/10/2012 |