=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376896308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUZMOKI MASSAGE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2012
-----------------------------------------------------
Last Update Date | 06/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 102ND AVE NE STE 300
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-4117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-504-6014
-----------------------------------------------------
Fax | 425-454-1995
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 102ND AVE NE STE 300
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-4117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-504-6014
-----------------------------------------------------
Fax | 425-454-1995
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMP/OWNER
-----------------------------------------------------
Name | JANENE HAMPTON
-----------------------------------------------------
Credential | LMP
-----------------------------------------------------
Telephone | 206-504-6014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA 60231483
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------