Healthcare Provider Details

I. General information

NPI: 1144767989
Provider Name (Legal Business Name): FAITH FISCHER-WHALEY LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 TOPAZ CT
WINLOCK WA
98596-9119
US

IV. Provider business mailing address

114 TOPAZ CT
WINLOCK WA
98596-9119
US

V. Phone/Fax

Practice location:
  • Phone: 303-807-2668
  • Fax:
Mailing address:
  • Phone: 303-807-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60684774
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: