Provider Demographics
NPI:1184845059
Name:SCOTT, MICHELE LEE (LMP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LEE
Last Name:SCOTT
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 1:41 FERGY LN
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-6991
Mailing Address - Country:US
Mailing Address - Phone:369-461-4799
Mailing Address - Fax:
Practice Address - Street 1:41 FERGY LN
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-6991
Practice Address - Country:US
Practice Address - Phone:369-461-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0203095OtherLABOR AND INDUSTRIES
WAMA00015538OtherSTATE LICENSE