=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417036930
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE AUBLE LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 612 SW 152ND ST
-----------------------------------------------------
City | BURIEN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98166-2213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-244-1466
-----------------------------------------------------
Fax | 206-246-4636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5018 22ND AVE NE
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98422-2065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-632-1336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | MA00021008
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------