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General NPI Number Information
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NPI Number | 1609206465
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Entity Type | Organization
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Legal Business Name | ACCIDENT CARE
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 5904 NE FOURTH PLAIN BLVD SUITE 101
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City | VANCOUVER
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State | WA
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Zip | 98661-6983
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Country | US
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Telephone | 360-696-8888
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Fax | 360-326-9556
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Provider Business Mailing Address
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Address Line | 5904 NE FOURTH PLAIN BLVD SUITE 101
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City | VANCOUVER
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State | WA
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Zip | 98661-6983
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Country | US
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Telephone | 360-696-8888
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Fax | 360-326-9556
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Authorized Official
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Title or Position | OWNER
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Name | DARREN FAHERTY
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Credential |
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Telephone | 503-256-3180
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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 | MA60389514
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License Number State | WA
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