Provider Demographics
NPI:1851964274
Name:WELCH, JAMES STEVEN
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STEVEN
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20902 LAKE SIXTEEN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-7576
Mailing Address - Country:US
Mailing Address - Phone:951-551-7119
Mailing Address - Fax:
Practice Address - Street 1:20902 LAKE SIXTEEN RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-7576
Practice Address - Country:US
Practice Address - Phone:951-551-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist