Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | OC60483333 | WA |
Y | 225700000X | Massage Therapist | MT60791072 | WA |
NPI | 1003293309 |
---|---|
Provider Name | Robert Wilkins |
First Address | Lakewood, WA 98499-1581 |
Second Address | Tacoma, WA 98408-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2015 |
Last Update Date | 20/11/2017 |