Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00015694 | WA |
NPI | 1023075819 |
---|---|
Provider Name | Ms. Pamela Dove Miller |
First Address | Sammamish, WA 98074-6732 |
Second Address | Issaquah, WA 98027-2421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 20/11/2019 |