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General NPI Number Information
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NPI Number | 1477693000
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Entity Type | Individual
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Provider Name | JIRAYA MICHIO ADDAMS LMP
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 901 BOREN AVE SUITE 1700 (LONG LIFE ACU)
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City | SEATTLE
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State | WA
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Zip | 98104-3595
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Country | US
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Telephone | 206-323-6824
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Fax |
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Provider Business Mailing Address
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Address Line | 901 BOREN AVE SUITE 1700 (LONG LIFE ACU)
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City | SEATTLE
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State | WA
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Zip | 98104-3595
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Country | US
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Telephone | 206-323-6824
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA00013087
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License Number State | WA
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