Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 60132964 | WA |
NPI | 1013239623 |
---|---|
Provider Name | Jane Ann Agard |
First Address | Sedro Woolley, WA 98284-9541 |
Second Address | Bellingham, WA 98225-5037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2010 |
Last Update Date | 23/02/2010 |