Provider Demographics
NPI:1013331073
Name:PATTERSON, JASON MICHELLE
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MICHELLE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:MICHELLE
Other - Last Name:THORPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4105 E EDGEWATER PL
Mailing Address - Street 2:APT. 168
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-2534
Mailing Address - Country:US
Mailing Address - Phone:808-640-5714
Mailing Address - Fax:
Practice Address - Street 1:4105 E EDGEWATER PL
Practice Address - Street 2:APT. 168
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-2534
Practice Address - Country:US
Practice Address - Phone:808-640-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60255466225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist