Healthcare Provider Details

I. General information

NPI: 1649908344
Provider Name (Legal Business Name): ONSIREE BUMRUNGMUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 196TH ST SW STE C
LYNNWOOD WA
98036-5980
US

IV. Provider business mailing address

6501 196TH ST SW STE C
LYNNWOOD WA
98036-5980
US

V. Phone/Fax

Practice location:
  • Phone: 425-775-2288
  • Fax:
Mailing address:
  • Phone: 425-775-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60952004
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: