Provider Demographics
NPI:1972969343
Name:JAMES, JACKLYN MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:MARIE
Last Name:JAMES
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 1:530 SOUTH 336TH STREET, STE C
Mailing Address - Street 2:MASSAGE FOR HEALTH AND DAY SPA, INC.
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:253-874-3857
Mailing Address - Fax:253-661-4007
Practice Address - Street 1:530 SOUTH 336TH STREET, STE C
Practice Address - Street 2:MASSAGE FOR HEALTH AND DAY SPA, INC.
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-874-3857
Practice Address - Fax:253-661-4007
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 0018217174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911990894OtherTIN