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General NPI Number Information
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NPI Number | 1588802656
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Entity Type | Organization
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Legal Business Name | HAZEL DELL THERAPEUTIC MASSAGE
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 01/28/2009
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Provider Practice Location Address
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Address Line | 6202 NE HIGHWAY 99 STE 4
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City | VANCOUVER
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State | WA
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Zip | 98665-8747
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Country | US
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Telephone | 360-695-6055
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Fax | 360-735-7628
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Provider Business Mailing Address
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Address Line | 6202 NE HIGHWAY 99 STE 4
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City | VANCOUVER
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State | WA
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Zip | 98665-8747
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Country | US
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Telephone | 360-695-6055
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Fax | 360-735-7628
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Authorized Official
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Title or Position | OWNER/THREAPIST
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Name | LORI M ZARZANA
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Credential | LMP
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Telephone | 360-695-6055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | MA00019181
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License Number State | WA
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