Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60776710 | WA |
NPI | 1003426446 |
---|---|
Provider Name | Sara Stamm |
First Address | Yelm, WA 98597-8788 |
Second Address | Yelm, WA 98597-8328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2020 |
Last Update Date | 31/07/2020 |