Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA61002258 | WA |
NPI | 1003451618 |
---|---|
Provider Name | Madison Kathleen Pritchard |
First Address | Bellingham, WA 98225-2903 |
Second Address | Bellingham, WA 98225-6622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2019 |
Last Update Date | 07/11/2019 |