Healthcare Provider Details

I. General information

NPI: 1417246919
Provider Name (Legal Business Name): MS. TIFFANY KUESPERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY KUESPERT LMP

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 NW MARKET ST STE E
SEATTLE WA
98107-5815
US

IV. Provider business mailing address

2201 SW HOLDEN ST APT E106
SEATTLE WA
98106-1767
US

V. Phone/Fax

Practice location:
  • Phone: 206-508-1265
  • Fax:
Mailing address:
  • Phone: 206-427-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00022290
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: