Healthcare Provider Details

I. General information

NPI: 1982974655
Provider Name (Legal Business Name): HEATHER MICHELLE MOXLEY LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 172ND ST NE STE N
ARLINGTON WA
98223-6336
US

IV. Provider business mailing address

3704 172ND ST NE STE N
ARLINGTON WA
98223-6336
US

V. Phone/Fax

Practice location:
  • Phone: 360-658-3818
  • Fax: 360-651-2344
Mailing address:
  • Phone: 360-658-3818
  • Fax: 360-651-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00020049
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: