Provider Demographics
NPI:1912600172
Name:HOCKETT, MIRANDA L (MA1400226)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:HOCKETT
Suffix:
Gender:F
Credentials:MA1400226
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 YAUGER WAY SW UNIT C104
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8912
Mailing Address - Country:US
Mailing Address - Phone:360-481-2345
Mailing Address - Fax:
Practice Address - Street 1:2627 CAPITAL MALL DR SW # B3A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8696
Practice Address - Country:US
Practice Address - Phone:360-786-6332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61400226225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist