Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA61193659 | WA |
NPI | 1013687425 |
---|---|
Provider Name | Mrs. Tricia Marie Davis |
First Address | Kennewick, WA 99337-5523 |
Second Address | Kennewick, WA 99336-5251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2021 |
Last Update Date | 16/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA61193659 | DEPARTMENT OF HEALTH STATE OF WA (01) | WA |