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General NPI Number Information
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NPI Number | 1194019315
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Entity Type | Individual
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Provider Name | TIA R HUTTON MSA, LAC
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Gender | Female
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 4003 212TH ST SW #G203
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-3571
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Country | US
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Telephone | 425-750-5192
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Fax |
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Provider Business Mailing Address
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Address Line | PMB 5166 PO BOX 257
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City | OLYMPIA
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State | WA
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Zip | 98507
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Country | US
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Telephone | 425-750-5192
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 60193575
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License Number State | WA
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