Healthcare Provider Details

I. General information

NPI: 1639712904
Provider Name (Legal Business Name): LARA MICHELE JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2019
Last Update Date: 10/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E HASTINGS RD
SPOKANE WA
99218-4901
US

IV. Provider business mailing address

5206 E SILVER SPUR LN
SPOKANE WA
99217-9334
US

V. Phone/Fax

Practice location:
  • Phone: 509-340-3303
  • Fax:
Mailing address:
  • Phone: 949-735-4713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60991424
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: