Healthcare Provider Details

I. General information

NPI: 1811564537
Provider Name (Legal Business Name): NORITAKE KOTOHDA MA60779709
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WENATCHEE AVE STE 110
WENATCHEE WA
98801-2201
US

IV. Provider business mailing address

25 N WENATCHEE AVE STE 110
WENATCHEE WA
98801-2201
US

V. Phone/Fax

Practice location:
  • Phone: 509-670-0327
  • Fax:
Mailing address:
  • Phone: 509-670-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60779709
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: