Provider Demographics
NPI:1083979413
Name:SMITH, TARA M (LMP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2718 E 57TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-6605
Mailing Address - Country:US
Mailing Address - Phone:509-448-9990
Mailing Address - Fax:509-448-9991
Practice Address - Street 1:2718 E 57TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-6605
Practice Address - Country:US
Practice Address - Phone:509-448-9990
Practice Address - Fax:509-448-9991
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA 00016938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist