Healthcare Provider Details

I. General information

NPI: 1306021415
Provider Name (Legal Business Name): SCOTT HUTSENPILLER L.M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16030 BOTHELL EVERETT HWY SUITE 200
MILL CREEK WA
98012-1741
US

IV. Provider business mailing address

16030 BOTHELL EVERETT HWY SUITE 200
MILL CREEK WA
98012-1741
US

V. Phone/Fax

Practice location:
  • Phone: 425-745-4910
  • Fax: 425-338-5709
Mailing address:
  • Phone: 425-745-4910
  • Fax: 425-338-5709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00024954
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: