Provider Demographics
NPI:1548617178
Name:NICOLE'S HEALING HANDS MASSAGE
Entity Type:Organization
Organization Name:NICOLE'S HEALING HANDS MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CHC
Authorized Official - Phone:509-797-5030
Mailing Address - Street 1:21 D ST SW STE B3
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1236
Mailing Address - Country:US
Mailing Address - Phone:509-797-5030
Mailing Address - Fax:509-352-2030
Practice Address - Street 1:21 D ST SW STE B3
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1236
Practice Address - Country:US
Practice Address - Phone:509-797-5030
Practice Address - Fax:509-352-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022603225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00022603OtherWASHINGTON STATE DEPT OF HEALTH