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NPI Code Detail

MEDICARE: JACOBA LEE WENTROSS LMP

MEDICARE: JACOBA LEE WENTROSS LMP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMA 60550937WA

General Provider Information

NPI Number : 1346781366
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOBA LEE WENTROSS LMP
Provider Business Mailing Address
First Line : 160 ROY ST
Second Line :
City : SEATTLE
State : WA
Zip : 98109-4162
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 160 ROY ST
Second Line :
City : SEATTLE
State : WA
Zip : 98109-4162
Country : US
Telephone Number : 206-453-4137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2017
Last Update Date : 03/09/2017

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Directions to “ JACOBA LEE WENTROSS LMP” Practice Location

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