=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700308053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SKILIER CULLERS WARREN LMP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2017
-----------------------------------------------------
Last Update Date | 07/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20124 BALLINGER WAY NE
-----------------------------------------------------
City | SHORELINE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98155-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-366-1111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1160 N 198TH ST UNIT H301
-----------------------------------------------------
City | SHORELINE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133-3682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-319-3010
-----------------------------------------------------
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 | MA60722226
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------