Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60817341 | WA |
NPI | 1003314386 |
---|---|
Provider Name | Jacqueline Alycia Anderson |
First Address | Spokane Valley, WA 99206-6859 |
Second Address | Spokane Valley, WA 99206-6859 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2018 |
Last Update Date | 01/02/2018 |