Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00019851 | WA |
NPI | 1003014978 |
---|---|
Provider Name | Melissa Jean Miller |
First Address | Tacoma, WA 98422-1058 |
Second Address | Auburn, WA 98002-4163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 08/07/2007 |