Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 14108 | OR |
N | 225700000X | Massage Therapist | MA00019248 | WA |
NPI | 1013117761 |
---|---|
Provider Name | Ms. Amy L. Tuttle |
First Address | Vancouver, WA 98661-4827 |
Second Address | Portland, OR 97209-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 03/06/2009 |