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General NPI Number Information
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NPI Number | 1700651866
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Entity Type | Individual
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Provider Name | AMDROMETER MARIE DAFFERN MA 61482763
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Gender | Female
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 3209 E 57TH AVE STE H
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City | SPOKANE
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State | WA
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Zip | 99223-7040
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Country | US
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Telephone | 509-283-1472
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 SE PROFESSIONAL MALL BLVD TRLR 301
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City | PULLMAN
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State | WA
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Zip | 99163-5434
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Country | US
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Telephone | 360-590-2542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA61482763
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License Number State | WA
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