Provider Demographics
NPI:1114418811
Name:SMITH, MEAGHAN MICHELLE
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:
Other - Last Name:HOUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10709 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1631
Mailing Address - Country:US
Mailing Address - Phone:509-466-9008
Mailing Address - Fax:
Practice Address - Street 1:10709 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1631
Practice Address - Country:US
Practice Address - Phone:509-466-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60855829225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist