Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00019893 | WA |
NPI | 1023152139 |
---|---|
Provider Name | Mrs. Jeri A. Simpson |
First Address | Kent, WA 98030-6210 |
Second Address | Kent, WA 98030-6210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |