Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | DH00006249 | WA |
Y | 225700000X | Massage Therapist | MA60550897 | WA |
NPI | 1023496528 |
---|---|
Provider Name | Mrs. Joelle Thompson |
First Address | Tacoma, WA 98418-6638 |
Second Address | Tacoma, WA 98406-7705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2015 |
Last Update Date | 15/05/2015 |