Provider Demographics
NPI:1164849840
Name:LEWIS-SPADY, BETHANY KAY (LMP, LMT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:KAY
Last Name:LEWIS-SPADY
Suffix:
Gender:F
Credentials:LMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-1902
Mailing Address - Country:US
Mailing Address - Phone:503-593-2430
Mailing Address - Fax:
Practice Address - Street 1:108 W 33RD ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-1902
Practice Address - Country:US
Practice Address - Phone:503-593-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60369935225700000X
OR20493225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist