Provider Demographics
NPI:1093007163
Name:SUWA, KAYOKO
Entity Type:Individual
Prefix:
First Name:KAYOKO
Middle Name:
Last Name:SUWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYOKO
Other - Middle Name:
Other - Last Name:SUWA-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16601 SR 9
Mailing Address - Street 2:# A
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-6313
Mailing Address - Country:US
Mailing Address - Phone:206-420-9310
Mailing Address - Fax:
Practice Address - Street 1:16601 SR 9
Practice Address - Street 2:# A
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-6313
Practice Address - Country:US
Practice Address - Phone:206-420-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60095168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist