Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60188254 | WA |
NPI | 1003117482 |
---|---|
Provider Name | Kristin Taylor |
First Address | La Center, WA 98629-3408 |
Second Address | Ridgefield, WA 98642-3422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2010 |
Last Update Date | 06/08/2018 |