Provider Demographics
NPI:1588733018
Name:BONIKOWSKI, CINNAMON ROSE (MASSAGE LICENSE)
Entity type:Individual
Prefix:
First Name:CINNAMON
Middle Name:ROSE
Last Name:BONIKOWSKI
Suffix:
Gender:F
Credentials:MASSAGE LICENSE
Other - Prefix:
Other - First Name:CINNAMON
Other - Middle Name:ATKINSON
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22215 39TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4242
Mailing Address - Country:US
Mailing Address - Phone:206-226-7094
Mailing Address - Fax:
Practice Address - Street 1:18927 33RD AVE W
Practice Address - Street 2:STE B
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4726
Practice Address - Country:US
Practice Address - Phone:425-776-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014908225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist