Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60888948 | WA |
NPI | 1003493347 |
---|---|
Provider Name | Linda Jane Miller |
First Address | Sequim, WA 98382-3185 |
Second Address | Sequim, WA 98382-3185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2021 |
Last Update Date | 24/03/2021 |