Healthcare Provider Details

I. General information

NPI: 1770611675
Provider Name (Legal Business Name): AZUR KOTEEN LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 36TH ST SUITE 330
SEATTLE WA
98103-8868
US

IV. Provider business mailing address

4145 38TH AVE S
SEATTLE WA
98118-1317
US

V. Phone/Fax

Practice location:
  • Phone: 206-931-2258
  • Fax:
Mailing address:
  • Phone: 206-931-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00019592
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: