Provider Demographics
NPI:1104209303
Name:STEMP, MADELINE IRENE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:IRENE
Last Name:STEMP
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:IRENE
Other - Last Name:RANNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 W CANAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3561
Mailing Address - Country:US
Mailing Address - Phone:509-551-8624
Mailing Address - Fax:
Practice Address - Street 1:920 W CANAL DR STE A
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-551-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60486969225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist