Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00014490 | WA |
NPI | 1003009531 |
---|---|
Provider Name | Terra J Jolly |
First Address | Olympia, WA 98502-8404 |
Second Address | Olympia, WA 98501-1031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2007 |
Last Update Date | 03/08/2011 |