MEDICARE: DERICK JAMES CACHOLA MA70056260

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
1	225700000X	Massage Therapist	MA70056260	WA

General Provider Information

NPI Number	:	1801745492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERICK JAMES CACHOLA MA70056260

Provider Business Mailing Address
First Line	:	12562 SE 230TH ST
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-3646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 S DAWSON ST STE 200
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-2100
Country	:	US
Telephone Number	:	206-307-4978
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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