Provider Demographics
NPI:1033345384
Name:THAEMERT, MIRANDA LEVONNE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:LEVONNE
Last Name:THAEMERT
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 1:3073 NW BUCKLIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9190
Mailing Address - Country:US
Mailing Address - Phone:360-551-9990
Mailing Address - Fax:360-692-0932
Practice Address - Street 1:3073 NW BUCKLIN HILL RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9190
Practice Address - Country:US
Practice Address - Phone:360-551-9990
Practice Address - Fax:360-692-0932
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60036699225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist