Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 601100729 | WA |
NPI | 1003160318 |
---|---|
Provider Name | Carolyn Brady |
First Address | Oak Harbor, WA 98277-4066 |
Second Address | Oak Harbor, WA 98277-8486 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2012 |
Last Update Date | 08/11/2012 |