Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00019749 | WA |
NPI | 1003020850 |
---|---|
Provider Name | Mrs. Joelle Marie Benoit Brekhus |
First Address | Ephrata, WA 98823-1804 |
Second Address | Ephrata, WA 98823-2135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0190967 | L&I (01) | WA |