Healthcare Provider Details

I. General information

NPI: 1093007163
Provider Name (Legal Business Name): KAYOKO SUWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYOKO SUWA-JOHNSON

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 SR 9 # A
SNOHOMISH WA
98296-6313
US

IV. Provider business mailing address

16601 SR 9 # A
SNOHOMISH WA
98296-6313
US

V. Phone/Fax

Practice location:
  • Phone: 206-420-9310
  • Fax:
Mailing address:
  • Phone: 206-420-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60095168
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: