Provider Demographics
NPI:1669644639
Name:KOSKI, ERIN NIKKOL
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NIKKOL
Last Name:KOSKI
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 1:3780 WESTMINSTER DR SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5841
Mailing Address - Country:US
Mailing Address - Phone:206-313-4764
Mailing Address - Fax:
Practice Address - Street 1:3780 WESTMINSTER DR SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5841
Practice Address - Country:US
Practice Address - Phone:206-313-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-29
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00024895225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist