Provider Demographics
NPI:1124580436
Name:GOFF, MERIAM THERESA (MA60936473)
Entity Type:Individual
Prefix:MRS
First Name:MERIAM
Middle Name:THERESA
Last Name:GOFF
Suffix:
Gender:F
Credentials:MA60936473
Other - Prefix:
Other - First Name:MERIAM
Other - Middle Name:THERESA
Other - Last Name:GOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA60936473
Mailing Address - Street 1:4731 176TH ST SW APT K8
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3429
Mailing Address - Country:US
Mailing Address - Phone:225-454-7226
Mailing Address - Fax:
Practice Address - Street 1:18927 33RD AVE W STE B
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4726
Practice Address - Country:US
Practice Address - Phone:425-776-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60936473225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist