Healthcare Provider Details

I. General information

NPI: 1497539019
Provider Name (Legal Business Name): SURIN HOHLACHOFF MA 61422890
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 EL CINE ST
COUPEVILLE WA
98239-9774
US

IV. Provider business mailing address

734 EL CINE ST
COUPEVILLE WA
98239-9774
US

V. Phone/Fax

Practice location:
  • Phone: 360-990-4590
  • Fax:
Mailing address:
  • Phone: 360-990-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61422890
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: