Healthcare Provider Details

I. General information

NPI: 1720154834
Provider Name (Legal Business Name): ANNIE K OCHOA LMP, CFEP, APP, CCST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE K WALL LMP, CFEP, APP

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 S 23RD ST
TACOMA WA
98405-1602
US

IV. Provider business mailing address

1008 126TH STREET CT E
TACOMA WA
98445-2913
US

V. Phone/Fax

Practice location:
  • Phone: 253-581-5200
  • Fax: 253-581-5203
Mailing address:
  • Phone: 206-817-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA7355
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00007355
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: