Healthcare Provider Details

I. General information

NPI: 1013119494
Provider Name (Legal Business Name): BETTY JANE HARTWELL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310D E LK SAMMAMISH PKWY SE
SAMMAMISH WA
98075
US

IV. Provider business mailing address

15511 OK MILL RD
SNOHOMISH WA
98290-7719
US

V. Phone/Fax

Practice location:
  • Phone: 425-557-8787
  • Fax: 425-557-6857
Mailing address:
  • Phone: 425-260-0598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number58647
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: