Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00023398 | WA |
N | 225700000X | Massage Therapist | MA00034498 | WA |
NPI | 1003173337 |
---|---|
Provider Name | Melissa Suzanne Berens |
First Address | Kent, WA 98031-3660 |
Second Address | Kent, WA 98031-3701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 27/04/2019 |