=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447899539
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY PARKER MA60811584
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2020
-----------------------------------------------------
Last Update Date | 10/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22002 64TH AVE W BLDG 3
-----------------------------------------------------
City | MOUNTLAKE TERRACE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98043-2528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-790-0195
-----------------------------------------------------
Fax | 206-801-1029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23014 EDMONDS WAY UNIT 207
-----------------------------------------------------
City | EDMONDS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98020-5064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-790-0195
-----------------------------------------------------
Fax | 206-801-1029
-----------------------------------------------------
=====================================================
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 | MA60811584
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------