Provider Demographics
NPI:1386299238
Name:BRASSARD-KUFFLER, ELANA MARIE
Entity type:Individual
Prefix:
First Name:ELANA
Middle Name:MARIE
Last Name:BRASSARD-KUFFLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2786 OLIE ANN PL
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-5041
Mailing Address - Country:US
Mailing Address - Phone:253-797-3682
Mailing Address - Fax:
Practice Address - Street 1:30741 3RD AVE STE 120
Practice Address - Street 2:
Practice Address - City:BLACK DIAMOND
Practice Address - State:WA
Practice Address - Zip Code:98010-9791
Practice Address - Country:US
Practice Address - Phone:360-886-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMASS.MA.60303938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist