Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00021979 | WA |
NPI | 1003233800 |
---|---|
Provider Name | Ms. Izumi Stephens |
First Address | Bainbridge Island, WA 98110-1113 |
Second Address | Bainbridge Island, WA 98110-1113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2014 |
Last Update Date | 19/03/2014 |