Basic Information
| Provider Information | |||||||||
| NPI: | 1669061024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKOCZEN | ||||||||
| FirstName: | ZEFIRE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LMT, LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4746 21ST AVE SW | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981061305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062250303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 680 NW GILMAN BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | ISSAQUAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980272454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254276562 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2021 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA00013368 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.