Provider Demographics
NPI:1306980354
Name:SILVA, JESSICA K SMARTT (BS, LMP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:K SMARTT
Last Name:SILVA
Suffix:
Gender:F
Credentials:BS, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 S SHELTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1966
Mailing Address - Country:US
Mailing Address - Phone:206-551-5382
Mailing Address - Fax:206-448-5586
Practice Address - Street 1:1702 S SHELTON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1966
Practice Address - Country:US
Practice Address - Phone:206-551-5382
Practice Address - Fax:206-448-5586
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00015362225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00015362OtherMASSAGE PRACTITIONER