=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093844318
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENERGETIC MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13128 TOTEM LAKE BLVD NE SUITE 201
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-2953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-825-8400
-----------------------------------------------------
Fax | 425-821-4075
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 715 13TH AVE W
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98033-4874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-595-3406
-----------------------------------------------------
Fax | 425-821-4075
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. SUSAN M. HAYES
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 425-825-8400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 479
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------