Provider Demographics
NPI:1598071599
Name:STA. MARIA, CHERRY TAMISIN
Entity Type:Individual
Prefix:MS
First Name:CHERRY
Middle Name:TAMISIN
Last Name:STA. MARIA
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 1:12227 78TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-4408
Mailing Address - Country:US
Mailing Address - Phone:206-291-5145
Mailing Address - Fax:
Practice Address - Street 1:10655 NE 4TH ST, SUITE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-455-2225
Practice Address - Fax:425-454-7767
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60173659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist