Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60324885 | WA |
NPI | 1003150376 |
---|---|
Provider Name | Miss Malerie Rebecca Jeannae Fateley |
First Address | Richland, WA 99352-2385 |
Second Address | Richland, WA 99352-4408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2012 |
Last Update Date | 26/11/2012 |