Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60305921 | WA |
NPI | 1003375874 |
---|---|
Provider Name | Kerri Davis |
First Address | Vancouver, WA 98685-2718 |
Second Address | Vancouver, WA 98685-2718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2019 |
Last Update Date | 19/03/2019 |