Provider Demographics
NPI:1770109027
Name:WYNTER OSTLUND MASSAGE THERAPY
Entity type:Organization
Organization Name:WYNTER OSTLUND MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE PRACTITONER
Authorized Official - Prefix:
Authorized Official - First Name:WYNTER
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:OSTLUND
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-869-6398
Mailing Address - Street 1:8008 NE 159TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-1031
Mailing Address - Country:US
Mailing Address - Phone:360-869-6398
Mailing Address - Fax:
Practice Address - Street 1:1710 W MAIN ST STE 213
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4318
Practice Address - Country:US
Practice Address - Phone:360-869-6398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty