Healthcare Provider Details

I. General information

NPI: 1518570845
Provider Name (Legal Business Name): LAURA HEPWORTH LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 198TH ST SW
LYNNWOOD WA
98036-6771
US

IV. Provider business mailing address

18949 FOREST PARK DR NE
LAKE FOREST PARK WA
98155-2435
US

V. Phone/Fax

Practice location:
  • Phone: 425-778-2325
  • Fax:
Mailing address:
  • Phone: 425-892-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60980553
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: