Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00018031 | WA |
NPI | 1023125382 |
---|---|
Provider Name | Tawny Anderson |
First Address | Bremerton, WA 98310-2852 |
Second Address | Bremerton, WA 98310-2852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 27/03/2008 |