Provider Demographics
NPI:1205025830
Name:GRACE, TATIANA MARIE (LMP LICENSED MASSAGE)
Entity Type:Individual
Prefix:MS
First Name:TATIANA
Middle Name:MARIE
Last Name:GRACE
Suffix:
Gender:F
Credentials:LMP LICENSED MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 SO 302ND PLACE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001
Mailing Address - Country:US
Mailing Address - Phone:253-946-9056
Mailing Address - Fax:253-804-5655
Practice Address - Street 1:3244 SO 302ND PLACE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001
Practice Address - Country:US
Practice Address - Phone:253-946-9056
Practice Address - Fax:253-804-5655
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006917225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist