Provider Demographics
NPI:1508073214
Name:ENOCHS, TASHA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:MARIE
Last Name:ENOCHS
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 1:902 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SULTAN
Mailing Address - State:WA
Mailing Address - Zip Code:98294-9440
Mailing Address - Country:US
Mailing Address - Phone:206-713-3081
Mailing Address - Fax:425-558-5676
Practice Address - Street 1:16148 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4318
Practice Address - Country:US
Practice Address - Phone:425-881-7790
Practice Address - Fax:425-558-5676
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019929174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist