Provider Demographics
NPI:1447899539
Name:PARKER, AMY (MA60811584)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA60811584
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:23014 EDMONDS WAY UNIT 207
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5064
Mailing Address - Country:US
Mailing Address - Phone:206-790-0195
Mailing Address - Fax:206-801-1029
Practice Address - Street 1:22002 64TH AVE W BLDG 3
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2528
Practice Address - Country:US
Practice Address - Phone:206-790-0195
Practice Address - Fax:206-801-1029
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60811584225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist