Provider Demographics
NPI:1194501114
Name:JOHNSON, TA'MERA LAKEYTA (MA61452349)
Entity type:Individual
Prefix:
First Name:TA'MERA
Middle Name:LAKEYTA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA61452349
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 90TH ST S
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-9111
Mailing Address - Country:US
Mailing Address - Phone:253-348-7182
Mailing Address - Fax:
Practice Address - Street 1:601 S PINE ST STE 201
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2795
Practice Address - Country:US
Practice Address - Phone:253-528-3294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61452349225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist