Provider Demographics
NPI:1457525594
Name:MASTERS, JENNIFER REBECCA (LMP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:REBECCA
Last Name:MASTERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:MASTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:1111 W HOLLY ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2922
Mailing Address - Country:US
Mailing Address - Phone:360-671-2713
Mailing Address - Fax:
Practice Address - Street 1:1111 W HOLLY ST
Practice Address - Street 2:SUITE F
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2922
Practice Address - Country:US
Practice Address - Phone:360-671-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009551225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0159055OtherL&I