Provider Demographics
NPI:1346485521
Name:BROOKS, MARISSA
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 1ST AVE W
Mailing Address - Street 2:STE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4156
Mailing Address - Country:US
Mailing Address - Phone:206-979-6362
Mailing Address - Fax:
Practice Address - Street 1:315 1ST AVE W
Practice Address - Street 2:STE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4156
Practice Address - Country:US
Practice Address - Phone:206-979-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00009941225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist