Provider Demographics
NPI:1750639522
Name:TSUKAMOTO, JACLYN MICHIKO (LMP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MICHIKO
Last Name:TSUKAMOTO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9671 N NEVADA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1146
Mailing Address - Country:US
Mailing Address - Phone:509-467-3336
Mailing Address - Fax:509-467-3970
Practice Address - Street 1:9671 N NEVADA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1146
Practice Address - Country:US
Practice Address - Phone:509-467-3336
Practice Address - Fax:509-467-3970
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 602277366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist