Healthcare Provider Details

I. General information

NPI: 1427274067
Provider Name (Legal Business Name): SAMANTHA C WIKAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6995 LITTLEROCK RD SW
TUMWATER WA
98512-7246
US

IV. Provider business mailing address

6995 LITTLEROCK RD SW
TUMWATER WA
98512-7246
US

V. Phone/Fax

Practice location:
  • Phone: 360-357-3009
  • Fax:
Mailing address:
  • Phone: 360-357-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00014058
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: