Provider Demographics
NPI:1174836399
Name:SMITH, MARLESHIA MICHELLE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MARLESHIA
Middle Name:MICHELLE
Last Name:SMITH
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 1:6818 278TH ST NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-6043
Mailing Address - Country:US
Mailing Address - Phone:425-232-2210
Mailing Address - Fax:
Practice Address - Street 1:6818 278TH ST NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6043
Practice Address - Country:US
Practice Address - Phone:425-232-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00025380225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist