Healthcare Provider Details

I. General information

NPI: 1700790995
Provider Name (Legal Business Name): IMISHKIN TEPIQWA FERRIS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 WESTLAKE AVE N STE 419
SEATTLE WA
98109-2707
US

IV. Provider business mailing address

307 SUMMIT AVE E APT 11
SEATTLE WA
98102-5200
US

V. Phone/Fax

Practice location:
  • Phone: 206-838-5318
  • Fax:
Mailing address:
  • Phone: 509-217-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70169263
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: