Provider Demographics
NPI:1093061616
Name:OMOTO, JOYCE EMI (LMP)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:EMI
Last Name:OMOTO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 6TH AVE
Mailing Address - Street 2:#832
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1896
Mailing Address - Country:US
Mailing Address - Phone:206-441-2505
Mailing Address - Fax:
Practice Address - Street 1:2200 6TH AVE
Practice Address - Street 2:#832
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1896
Practice Address - Country:US
Practice Address - Phone:206-441-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60303912225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist