Provider Demographics
NPI:1770874679
Name:SIFFERMAN, CHARISMA JIMENEA (LMP)
Entity type:Individual
Prefix:MRS
First Name:CHARISMA
Middle Name:JIMENEA
Last Name:SIFFERMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CHARISMA
Other - Middle Name:JIMENEA
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:5027 15TH AVE NE
Mailing Address - Street 2:APT 301
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4347
Mailing Address - Country:US
Mailing Address - Phone:206-697-6837
Mailing Address - Fax:
Practice Address - Street 1:701 5TH AVE
Practice Address - Street 2:STE 212
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-7097
Practice Address - Country:US
Practice Address - Phone:206-464-4250
Practice Address - Fax:206-829-2051
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60199831225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist