Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60152331 | WA |
NPI | 1003134172 |
---|---|
Provider Name | Miss Hannah Mackenzie Listle |
First Address | Kingston, WA 98346-9603 |
Second Address | Kingston, WA 98346-9603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2010 |
Last Update Date | 13/05/2010 |