Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60840637 | WA |
NPI | 1013563105 |
---|---|
Provider Name | Rebecca Jean Wilkins |
First Address | Everett, WA 98203-3089 |
Second Address | Seattle, WA 98115-2047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2019 |
Last Update Date | 14/08/2019 |