Provider Demographics
NPI:1003203217
Name:SPAULDING, MERANDA (LMT)
Entity Type:Individual
Prefix:
First Name:MERANDA
Middle Name:
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 875263
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-5263
Mailing Address - Country:US
Mailing Address - Phone:907-947-7258
Mailing Address - Fax:
Practice Address - Street 1:700 E RAILROAD AVE STE 1
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8136
Practice Address - Country:US
Practice Address - Phone:907-357-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101451225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist