Healthcare Provider Details

I. General information

NPI: 1669061024
Provider Name (Legal Business Name): ZEFIRE M SKOCZEN LMT, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 NW GILMAN BLVD STE A
ISSAQUAH WA
98027-2454
US

IV. Provider business mailing address

4746 21ST AVE SW
SEATTLE WA
98106-1305
US

V. Phone/Fax

Practice location:
  • Phone: 425-427-6562
  • Fax:
Mailing address:
  • Phone: 206-225-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00013368
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: