Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA61160854 | WA |
NPI | 1003484171 |
---|---|
Provider Name | Ms. Tiffany Ann Wax |
First Address | Spokane Valley, WA 99216-2852 |
Second Address | Spokane Valley, WA 99216-2852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2021 |
Last Update Date | 15/01/2022 |