Provider Demographics
NPI:1982269114
Name:WASMER, JEFFREY FRANK (MA 60214980)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:FRANK
Last Name:WASMER
Suffix:
Gender:M
Credentials:MA 60214980
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 NE SUNSET BLVD APT B106
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4283
Mailing Address - Country:US
Mailing Address - Phone:253-439-8566
Mailing Address - Fax:
Practice Address - Street 1:4808 NE SUNSET BLVD APT B106
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4283
Practice Address - Country:US
Practice Address - Phone:253-439-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWDL75B44D43B225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist