Active NPI
Mary Helen Waggoner, LMP
- Massage Therapist
- Fife, WA
National Provider Identifier
1033388624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA00023466
- Practice address
- 4210 20TH St E
Ste D
Fife, WA 98424-1830 - Phone
- (253) 922-0450
- Fax
- (253) 926-1720
- NPI assigned
- Feb 27, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA00023466 | WA | Primary |
Addresses
Primary practice location
4210 20TH St E
Ste D
Fife, WA 98424-1830
Mailing address
4210 20TH St E
Ste D
Fife, WA 98424-1830
Phone (253) 922-0450
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00023466 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204070400000",
"number": "1033388624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4210 20TH ST E",
"address_2": "STE D",
"city": "FIFE",
"state": "WA",
"postal_code": "984241830",
"telephone_number": "253-922-0450",
"fax_number": "253-926-1720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4210 20TH ST E",
"address_2": "STE D",
"city": "FIFE",
"state": "WA",
"postal_code": "984241830",
"telephone_number": "253-922-0450",
"fax_number": "253-926-1720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "MARY",
"middle_name": "HELEN",
"name_prefix": "Mrs.",
"credential": "LMP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-27",
"last_updated": "2008-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA00023466",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fife, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.