Individual
GINA MARIE KETOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
6505 ROOSEVELT WAY NE, SEATTLE, WA 98115-6626
(206) 524-6289
(206) 524-6289
Mailing address
6505 ROOSEVELT WAY NE, SEATTLE, WA 98115-6626
(206) 524-6289
(206) 524-6289
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
00001886
WA
Other
Enumeration date
08/04/2008
Last updated
08/04/2008
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