Provider Demographics
NPI:1144580218
Name:MOUA, SHENG
Entity Type:Individual
Prefix:
First Name:SHENG
Middle Name:
Last Name:MOUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SW 37TH TER
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8441
Mailing Address - Country:US
Mailing Address - Phone:971-285-6745
Mailing Address - Fax:
Practice Address - Street 1:1104 MAIN ST
Practice Address - Street 2:SUITE M105
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2999
Practice Address - Country:US
Practice Address - Phone:360-450-3889
Practice Address - Fax:360-450-3887
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60261701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist