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General NPI Number Information
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NPI Number | 1225797640
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Entity Type | Individual
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Provider Name | SHEYANNE LEE FASSNACHT MA60615929
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Gender | Female
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 4520 INTELCO LOOP SE STE 4E
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City | LACEY
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State | WA
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Zip | 98503-6012
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Country | US
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Telephone | 360-402-6776
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Fax |
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Provider Business Mailing Address
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Address Line | 7702 50TH AVE SE
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City | OLYMPIA
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State | WA
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Zip | 98513-4639
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Country | US
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Telephone | 253-508-9809
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60615929
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License Number State | WA
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