=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700092111
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONIA MORTON LMP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 805 S 219TH ST # A
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98198-6340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-878-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22501 MARINE VIEW DR S APT 4
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98198-6830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-854-5402
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | MA00015350
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------