Provider Demographics
NPI:1952886467
Name:GLOVER, TARAH (MS, CN, LMT)
Entity type:Individual
Prefix:
First Name:TARAH
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:MS, CN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 116TH AVE NE APT B
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8131
Mailing Address - Country:US
Mailing Address - Phone:425-922-1696
Mailing Address - Fax:
Practice Address - Street 1:7014 116TH AVE NE APT B
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8131
Practice Address - Country:US
Practice Address - Phone:425-922-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60899384225700000X
WANU61602147133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist