Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 60072924 | WA |
NPI | 1013231869 |
---|---|
Provider Name | Joelnell J. Hawkins |
First Address | Tacoma, WA 98465-1406 |
Second Address | Tacoma, WA 98465-1406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2010 |
Last Update Date | 23/03/2010 |