Provider Demographics
NPI:1356477988
Name:CABATIT, JESSICA (LMP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CABATIT
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 1:22019 39TH PL S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-8429
Mailing Address - Country:US
Mailing Address - Phone:425-269-5377
Mailing Address - Fax:
Practice Address - Street 1:1100 19TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3505
Practice Address - Country:US
Practice Address - Phone:206-324-0664
Practice Address - Fax:206-324-1969
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018178225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0190470OtherDEPT OF LABOR & INDUSTRIE