Provider Demographics
NPI:1225462195
Name:OHMAN SONNBACK, MARITA (LMP)
Entity Type:Individual
Prefix:MS
First Name:MARITA
Middle Name:
Last Name:OHMAN SONNBACK
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 1:19232 92ND AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-2550
Mailing Address - Country:US
Mailing Address - Phone:425-772-6167
Mailing Address - Fax:
Practice Address - Street 1:6817 208TH ST SW
Practice Address - Street 2:UNIT 5388
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5800
Practice Address - Country:US
Practice Address - Phone:425-772-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60317300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist