Provider Demographics
NPI:1548627219
Name:OFTE, VANESSA ANNE (MA)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:ANNE
Last Name:OFTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-8017
Mailing Address - Country:US
Mailing Address - Phone:360-349-8387
Mailing Address - Fax:
Practice Address - Street 1:1207 S 27TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-8017
Practice Address - Country:US
Practice Address - Phone:360-349-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60472952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist