Healthcare Provider Details

I. General information

NPI: 1104178664
Provider Name (Legal Business Name): AMY SENESAC L.AC., LMT, DIPL. OM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 NE 65TH ST
SEATTLE WA
98115-5542
US

IV. Provider business mailing address

21031 101ST AVE SE
KENT WA
98031-2060
US

V. Phone/Fax

Practice location:
  • Phone: 206-267-0863
  • Fax:
Mailing address:
  • Phone: 773-616-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number84000150A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60798007
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60797978
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: