Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003985888 |
---|---|
Provider Name | Maria Lynn Selph |
First Address | Silverdale, WA 98383 |
Second Address | Silverdale, WA 98383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 16/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0186208 | LTI (01) | WA |
91118703308 | KRS INSURANCE (01) | WA |