Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60319964 | WA |
NPI | 1003152075 |
---|---|
Provider Name | Megan Martin |
First Address | Seattle, WA 98107-2358 |
Second Address | Seattle, WA 98107-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2012 |
Last Update Date | 19/12/2012 |