Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 60770367 | WA |
NPI | 1013430693 |
---|---|
Provider Name | Cassidy Doohan |
First Address | Everett, WA 98208-8936 |
Second Address | Everett, WA 98208-8936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2017 |
Last Update Date | 22/08/2017 |