Healthcare Provider Details

I. General information

NPI: 1639764848
Provider Name (Legal Business Name): CLAIRE KOTARSKI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASIMIR KOTARSKI

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ROY ST STE 100
SEATTLE WA
98109-4162
US

IV. Provider business mailing address

411 14TH AVE E
SEATTLE WA
98112-4508
US

V. Phone/Fax

Practice location:
  • Phone: 206-453-4137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.61111693
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: