Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 60892819 | WA |
NPI | 1013478551 |
---|---|
Provider Name | Crystal Ann Lavallee |
First Address | Bellingham, WA 98226-3870 |
Second Address | Bellingham, WA 98226-3870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |