Provider Demographics
NPI:1861822652
Name:STILL WATERS MASSAGE INC
Entity Type:Organization
Organization Name:STILL WATERS MASSAGE INC
Other - Org Name:STILL WATERS MASSAGE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-319-1123
Mailing Address - Street 1:1800 BICKFORD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1771
Mailing Address - Country:US
Mailing Address - Phone:425-319-1123
Mailing Address - Fax:360-863-2649
Practice Address - Street 1:1800 BICKFORD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1771
Practice Address - Country:US
Practice Address - Phone:425-319-1123
Practice Address - Fax:360-863-2649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015044225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty