Provider Demographics
NPI:1194019315
Name:HUTTON, TIA R (MSA, LAC)
Entity Type:Individual
Prefix:
First Name:TIA R
Middle Name:
Last Name:HUTTON
Suffix:
Gender:F
Credentials:MSA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 5166 PO BOX 257
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507
Mailing Address - Country:US
Mailing Address - Phone:425-750-5192
Mailing Address - Fax:
Practice Address - Street 1:4003 212TH ST SW
Practice Address - Street 2:#G203
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-3571
Practice Address - Country:US
Practice Address - Phone:425-750-5192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60193575171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist