Healthcare Provider Details

I. General information

NPI: 1871644971
Provider Name (Legal Business Name): MICHELLE MARTIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 TALLMAN AVE NW STE 214-217
SEATTLE WA
98107-3935
US

IV. Provider business mailing address

5355 TALLMAN AVE NW STE 214-217
SEATTLE WA
98107-3935
US

V. Phone/Fax

Practice location:
  • Phone: 206-675-1740
  • Fax: 206-675-1043
Mailing address:
  • Phone: 206-675-1740
  • Fax: 206-675-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00022522
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: