Healthcare Provider Details

I. General information

NPI: 1619204922
Provider Name (Legal Business Name): JAMIE LYNN LOWE LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 TACOMA AVE. W.
WESTPORT WA
98595
US

IV. Provider business mailing address

PO BOX 692
WESTPORT WA
98595-0692
US

V. Phone/Fax

Practice location:
  • Phone: 360-593-3915
  • Fax:
Mailing address:
  • Phone: 360-593-3915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60095328
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: