Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 00016052 | WA |
NPI | 1013263771 |
---|---|
Provider Name | Leilani Kylie Okalani |
First Address | Walla Walla, WA 99362-3009 |
Second Address | Walla Walla, WA 99362-3009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2012 |
Last Update Date | 31/07/2012 |