Provider Demographics
NPI:1437680485
Name:DECKMAN COOPER, JILL SUZANNE (MA60745488)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:DECKMAN COOPER
Suffix:
Gender:F
Credentials:MA60745488
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7541 MARY AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5332
Mailing Address - Country:US
Mailing Address - Phone:206-661-8396
Mailing Address - Fax:
Practice Address - Street 1:7541 MARY AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5332
Practice Address - Country:US
Practice Address - Phone:206-661-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60745488225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist