Provider Demographics
NPI:1265650105
Name:MCKEEN, DEMA MAY (LMP)
Entity Type:Individual
Prefix:
First Name:DEMA
Middle Name:MAY
Last Name:MCKEEN
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:PO BOX 5194
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5194
Mailing Address - Country:US
Mailing Address - Phone:425-303-9213
Mailing Address - Fax:
Practice Address - Street 1:4418 RUCKER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2397
Practice Address - Country:US
Practice Address - Phone:425-258-1969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016696225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist