Provider Demographics
NPI:1184189565
Name:MERMAID COVE MASSAGE & WELLNESS, LLC
Entity Type:Organization
Organization Name:MERMAID COVE MASSAGE & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MALIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:253-414-2964
Mailing Address - Street 1:17725 69TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2472
Mailing Address - Country:US
Mailing Address - Phone:253-414-2964
Mailing Address - Fax:
Practice Address - Street 1:812 E MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3364
Practice Address - Country:US
Practice Address - Phone:253-414-2964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty