Provider Demographics
NPI:1174815369
Name:HOWELL, THERESA MICHELLE JEWELL (LMP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MICHELLE JEWELL
Last Name:HOWELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 192ND ST E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-5010
Mailing Address - Country:US
Mailing Address - Phone:253-203-4655
Mailing Address - Fax:
Practice Address - Street 1:2711 N 21ST ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-7519
Practice Address - Country:US
Practice Address - Phone:253-203-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60208136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist