Healthcare Provider Details

I. General information

NPI: 1306062252
Provider Name (Legal Business Name): MELODY HULSE LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 128TH ST SW
EVERETT WA
98204-6315
US

IV. Provider business mailing address

919 128TH ST SW
EVERETT WA
98204-6315
US

V. Phone/Fax

Practice location:
  • Phone: 425-347-8614
  • Fax: 425-348-6986
Mailing address:
  • Phone: 425-347-8614
  • Fax: 425-348-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00022382
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: