Individual
EVETTE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
929 ECKARD PL, PORT ANGELES, WA 98362-6776
(360) 477-6358
Mailing address
929 ECKARD PL, PORT ANGELES, WA 98362-6776
(360) 477-6358
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60108107
WA
Other
Enumeration date
02/27/2010
Last updated
04/21/2010
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