Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60823097 | WA |
NPI | 1003316688 |
---|---|
Provider Name | Jaymie Noelle Poage |
First Address | East Wenatchee, WA 98802-3932 |
Second Address | East Wenatchee, WA 98802-3932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2018 |
Last Update Date | 20/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA60823097 | MASSAGE (01) | WA |