Provider Demographics
NPI:1043855620
Name:FITCH, ELLEN L
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:FITCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7422 DECATUR PL
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-8907
Mailing Address - Country:US
Mailing Address - Phone:206-818-9087
Mailing Address - Fax:
Practice Address - Street 1:7422 DECATUR PL
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-8907
Practice Address - Country:US
Practice Address - Phone:206-818-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61131314225700000X
NY031214225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61131314OtherMASSAGE THERAPY LICENSE
NY031214OtherMASSAGE THERAPY LICENSE