Provider Demographics
NPI:1144493842
Name:STILL, TARA J
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:STILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:J
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:6501 196TH ST SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5980
Mailing Address - Country:US
Mailing Address - Phone:425-775-2288
Mailing Address - Fax:
Practice Address - Street 1:6501 196TH ST SW
Practice Address - Street 2:SUITE C
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5980
Practice Address - Country:US
Practice Address - Phone:425-775-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024706225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist