Provider Demographics
NPI:1609346758
Name:MCCULLOUGH, SARAH RACHEL (MA60135663)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:RACHEL
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MA60135663
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3535 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5052
Mailing Address - Country:US
Mailing Address - Phone:360-491-9135
Mailing Address - Fax:360-923-9382
Practice Address - Street 1:3700 MARTIN WAY E STE 108
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5052
Practice Address - Country:US
Practice Address - Phone:360-561-0171
Practice Address - Fax:360-915-7857
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60135663225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1560016OtherAMTA