=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730552969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLLEEN WRIGHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2015
-----------------------------------------------------
Last Update Date | 11/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16111 SE MCGILLIVRAY BLVD STE A
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98683-9033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-254-0994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6703 SE 382ND AVE
-----------------------------------------------------
City | WASHOUGAL
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98671-9775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-627-0983
-----------------------------------------------------
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 | MA 6060777
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------