Provider Demographics
NPI:1093872004
Name:LWJH LLC OLYMPIC DAY SPA
Entity Type:Organization
Organization Name:LWJH LLC OLYMPIC DAY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-697-3767
Mailing Address - Street 1:PO BOX 2706
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-2706
Mailing Address - Country:US
Mailing Address - Phone:360-697-3767
Mailing Address - Fax:
Practice Address - Street 1:18820 FRONT ST
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-697-3767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006874225700000X
WAMA00020574225700000X
WAMA00018810225700000X
WAMA00017400225700000X
WAMA00019751225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty