Provider Demographics
NPI:1073953634
Name:BRAZEAU, SARA CHRISTINE (MA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:CHRISTINE
Last Name:BRAZEAU
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:CHRISTINE
Other - Last Name:BRAZEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:6330 21ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1620
Mailing Address - Country:US
Mailing Address - Phone:509-833-1046
Mailing Address - Fax:
Practice Address - Street 1:8202 NE STATE HIGHWAY 104
Practice Address - Street 2:SUITE 105
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9454
Practice Address - Country:US
Practice Address - Phone:360-297-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60202753225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist