=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356780878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICKY MARIE FISHER LMP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2013
-----------------------------------------------------
Last Update Date | 06/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1422 31ST AVE S
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98144-3910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-375-6559
-----------------------------------------------------
Fax | 206-971-5020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5152 S JUNEAU ST
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98118-2932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-307-8081
-----------------------------------------------------
Fax | 206-971-5020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA0022589
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------