Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 60389523 | WA |
NPI | 1013330422 |
---|---|
Provider Name | Tracy Osterhout |
First Address | Battle Ground, WA 98604 |
Second Address | Battle Ground, WA 98604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2014 |
Last Update Date | 22/01/2014 |