Provider Demographics
NPI:1174341812
Name:HOSTETTER, AMBER DARLENE (LMT, CCT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DARLENE
Last Name:HOSTETTER
Suffix:
Gender:F
Credentials:LMT, CCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 244TH ST SW APT V203
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-6590
Mailing Address - Country:US
Mailing Address - Phone:206-779-6054
Mailing Address - Fax:
Practice Address - Street 1:7500 212TH ST SW
Practice Address - Street 2:ROOM 1, SUITE 107
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7641
Practice Address - Country:US
Practice Address - Phone:206-779-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60592239225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist