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General NPI Number Information
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NPI Number | 1821501263
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Entity Type | Individual
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Provider Name | OLEKSANDR STETSYUK LMT
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Gender | Male
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 18530 156TH AVE NE STE 100
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City | WOODINVILLE
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State | WA
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Zip | 98072-8409
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Country | US
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Telephone | 425-287-3691
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Fax |
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Provider Business Mailing Address
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Address Line | 5510 227TH ST SE
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City | BOTHELL
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State | WA
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Zip | 98021-8006
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Country | US
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Telephone | 425-287-3691
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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 | MA60791969
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License Number State | WA
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