Healthcare Provider Details

I. General information

NPI: 1235981101
Provider Name (Legal Business Name): TIFFANY LLAMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 MARTIN WAY E STE 207
LACEY WA
98516-6610
US

IV. Provider business mailing address

8650 MARTIN WAY E STE 207
LACEY WA
98516-6610
US

V. Phone/Fax

Practice location:
  • Phone: 360-951-4504
  • Fax: 877-848-7757
Mailing address:
  • Phone: 360-951-4504
  • Fax: 877-848-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61508656
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: