=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518365261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEATTLE ASIAN MEDICINE AND MARTIAL ARTS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2014
-----------------------------------------------------
Last Update Date | 12/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12025 LAKE CITY WAY NE SUITE B
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98125-5331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-363-0471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12025 LAKE CITY WAY NE SUITE B
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98125-5331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-363-0471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPA MANAGER
-----------------------------------------------------
Name | MRS. MARY WANDA CASHMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-363-0471
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA00023022
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------