Provider Demographics
NPI:1073131629
Name:MEEK, SHAELYNN (ATC)
Entity Type:Individual
Prefix:
First Name:SHAELYNN
Middle Name:
Last Name:MEEK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 E WARM SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9693
Mailing Address - Country:US
Mailing Address - Phone:208-809-8305
Mailing Address - Fax:
Practice Address - Street 1:1350 E WARM SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9693
Practice Address - Country:US
Practice Address - Phone:208-809-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCC238010G2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer