Provider Demographics
NPI:1871737445
Name:REEVES, JESSICA RYAN
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:RYAN
Last Name:REEVES
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 1:6019 26TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7107
Mailing Address - Country:US
Mailing Address - Phone:206-383-0408
Mailing Address - Fax:
Practice Address - Street 1:600 1ST AVE
Practice Address - Street 2:SUITE 536
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2216
Practice Address - Country:US
Practice Address - Phone:206-383-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019588225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist