Healthcare Provider Details

I. General information

NPI: 1912346222
Provider Name (Legal Business Name): OLYMPUS SPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8615 S TACOMA WAY
LAKEWOOD WA
98499-4542
US

IV. Provider business mailing address

8615 S TACOMA WAY
LAKEWOOD WA
98499-4542
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-3355
  • Fax:
Mailing address:
  • Phone: 253-588-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number00016383
License Number StateWA

VIII. Authorized Official

Name: MS. RACHAEL SUZANNE SCHATZ
Title or Position: MASSAGE THERAPIST
Credential: L.M.P.
Phone: 253-221-5761