Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA000023442 | WA |
NPI | 1003002403 |
---|---|
Provider Name | Tammy A Lopez |
First Address | Othello, WA 99344-1055 |
Second Address | Othello, WA 99344-1055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2007 |
Last Update Date | 19/09/2007 |