Provider Demographics
NPI:1083022750
Name:MECKEL, JAMIE MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:MARIE
Last Name:MECKEL
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 1:7683 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-6188
Mailing Address - Country:US
Mailing Address - Phone:208-440-2249
Mailing Address - Fax:
Practice Address - Street 1:7683 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6188
Practice Address - Country:US
Practice Address - Phone:208-440-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist