Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00016254 | WA |
NPI | 1023158318 |
---|---|
Provider Name | Mrs. Donna R Vodopich |
First Address | Bellingham, WA 98226-7736 |
Second Address | Bellingham, WA 98226-7736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0187083 | DEPARTMENT OF L & I (01) | WA |
5452AR | REGENCE INSURANCE (01) | WA |