Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60898168 | WA |
NPI | 1003388596 |
---|---|
Provider Name | Mariko O Spalding |
First Address | Bothell, WA 98041-2072 |
Second Address | Bothell, WA 98011-3425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2018 |
Last Update Date | 20/12/2018 |