Healthcare Provider Details

I. General information

NPI: 1497289995
Provider Name (Legal Business Name): TIFFANY LATSHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 04/10/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 203RD ST SE
BOTHELL WA
98012-9699
US

IV. Provider business mailing address

206 203RD ST SE
BOTHELL WA
98012-9699
US

V. Phone/Fax

Practice location:
  • Phone: 425-218-3721
  • Fax:
Mailing address:
  • Phone: 425-218-3721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60729874
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: