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General NPI Number Information
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NPI Number | 1235670860
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Entity Type | Organization
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Legal Business Name | NW ZEN
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 14521 80TH AVE E
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City | PUYALLUP
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State | WA
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Zip | 98375-6918
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Country | US
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Telephone | 253-355-6981
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Fax |
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Provider Business Mailing Address
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Address Line | 704 25TH ST SE APT C
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City | PUYALLUP
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State | WA
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Zip | 98372-4138
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Country | US
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Telephone | 253-355-6981
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | KATELYN N HOGLUND
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Credential |
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Telephone | 253-355-6981
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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 | 60725084
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License Number State | WA
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