Healthcare Provider Details

I. General information

NPI: 1447466750
Provider Name (Legal Business Name): JOANNE CHARLOTTE COBBS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 KING ROAD POB 411
WINLOCK WA
98596
US

IV. Provider business mailing address

839 KING ROAD POB 411
WINLOCK WA
98596
US

V. Phone/Fax

Practice location:
  • Phone: 360-785-7516
  • Fax:
Mailing address:
  • Phone: 360-785-7516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00006247
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: