Provider Demographics
NPI:1003672098
Name:KOONS, MARIAMA BANDEH
Entity Type:Individual
Prefix:
First Name:MARIAMA
Middle Name:BANDEH
Last Name:KOONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 NE 174TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-4933
Mailing Address - Country:US
Mailing Address - Phone:206-550-6807
Mailing Address - Fax:
Practice Address - Street 1:420 5TH AVE S STE 207
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3632
Practice Address - Country:US
Practice Address - Phone:206-550-6807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61216772225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist