Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60471664 | WA |
NPI | 1013313808 |
---|---|
Provider Name | Mica Lakip |
First Address | Seattle, WA 98104-1928 |
Second Address | Seattle, WA 98104-7097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2014 |
Last Update Date | 06/11/2014 |