Provider Demographics
NPI:1003138454
Name:SEMA, MIREILLE P (LMP)
Entity Type:Individual
Prefix:
First Name:MIREILLE
Middle Name:P
Last Name:SEMA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14351 STONE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7020
Mailing Address - Country:US
Mailing Address - Phone:206-295-6866
Mailing Address - Fax:
Practice Address - Street 1:23303 HWY 99 STE G
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8762
Practice Address - Country:US
Practice Address - Phone:425-697-5188
Practice Address - Fax:425-673-1928
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60130466225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist