Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00017908 | WA |
NPI | 1003945023 |
---|---|
Provider Name | Miss Blair White |
First Address | Olympia, WA 98502-1111 |
Second Address | Olympia, WA 98502-1111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 17/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
912108094 | (02) | WA |