Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 00016911 | WA |
NPI | 1003242538 |
---|---|
Provider Name | Mrs. Kristin Tessier |
First Address | Bothell, WA 98021-8883 |
Second Address | Bellevue, WA 98004-3825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2013 |
Last Update Date | 16/09/2013 |