Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60466631 | WA |
NPI | 1013321405 |
---|---|
Provider Name | Sarah Faye Nickel |
First Address | Federal Way, WA 98003-6821 |
Second Address | Federal Way, WA 98003-6821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2014 |
Last Update Date | 13/06/2014 |