Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA17604 | WA |
NPI | 1023185683 |
---|---|
Provider Name | Mrs. Deborah D. Baker |
First Address | Mill Creek, WA 98012-5768 |
Second Address | Bothell, WA 98011-1981 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |