Individual
TIA P EPONA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4720 YELM HWY SE, LACEY, WA 98503-4986
(360) 491-4359
Mailing address
4720 YELM HWY SE, LACEY, WA 98503-4986
(360) 491-4359
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60204245
WA
Other
Enumeration date
05/20/2011
Last updated
11/14/2023
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