Provider Demographics
NPI:1164544664
Name:OSTERBERG, JEAN TOSHIKO (LMP)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:TOSHIKO
Last Name:OSTERBERG
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 1:2320 N ATLANTIC ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4811
Mailing Address - Country:US
Mailing Address - Phone:509-327-8306
Mailing Address - Fax:509-327-8306
Practice Address - Street 1:2320 N ATLANTIC ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4811
Practice Address - Country:US
Practice Address - Phone:509-327-8306
Practice Address - Fax:509-327-8306
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA16669225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist