Provider Demographics
NPI:1679138184
Name:CLINTON, NATASHA MARIE (MA60942049)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MARIE
Last Name:CLINTON
Suffix:
Gender:F
Credentials:MA60942049
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 209TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-6947
Mailing Address - Country:US
Mailing Address - Phone:206-495-2827
Mailing Address - Fax:
Practice Address - Street 1:916 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5542
Practice Address - Country:US
Practice Address - Phone:206-267-0863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60942049225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA