Provider Demographics
NPI:1194533794
Name:FRASER, BRIAN (MT-BC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:FRASER
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 5TH AVE N APT 304
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3353
Mailing Address - Country:US
Mailing Address - Phone:908-456-3464
Mailing Address - Fax:
Practice Address - Street 1:1401 5TH AVE N APT 304
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3353
Practice Address - Country:US
Practice Address - Phone:908-456-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11914225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist